Ebola: NEJM - New Clade, WHO Messaging & Updated FAQ

Credit @UNMILNews

 

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While our attentions have understandably been diverted by the MERS coronavirus outbreak in the Middle East, the battle against a large Ebola outbreak in west Africa continues, and this morning we have updated numbers and some interesting news on that front. 

 

Yesterday the NEJM published a preliminary report on this outbreak, breaking the news that the viral culprit is a new strain of Ebola, not an imported strain of Ebola Zaire as first thought.

Although the two most common strains of Ebola known to cause outbreaks are Ebola Zaire (EBOV) and Ebola Sudan (SUDV), three other strains have previously been identified; Bundibugyo ebolavirus (BDBV), rarely seen Taï Forest ebolavirus (TAFV), and a strain found in the Philippines - not known to cause illness in humans - called Ebola Reston (RESTV) (see A Brief History of Ebola).

 

A link and a couple of snippets from the NEJM report follows:

 

Brief Report

Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report

Sylvain Baize, Ph.D., Delphine Pannetier, Ph.D., Lisa Oestereich, M.Sc., Toni Rieger, Ph.D., Lamine Koivogui, Ph.D., N'Faly Magassouba, Ph.D., Barrè Soropogui, M.Sc., Mamadou Saliou Sow, M.D., Sakoba Keïta, M.D., Hilde De Clerck, M.D., Amanda Tiffany, M.P.H., Gemma Dominguez, B.Sc., Mathieu Loua, M.D., Alexis Traoré, M.D., Moussa Kolié, M.D., Emmanuel Roland Malano, M.D., Emmanuel Heleze, M.D., Anne Bocquin, M.Sc., Stephane Mély, M.Sc., Hervé Raoul, Ph.D., Valérie Caro, Ph.D., Dániel Cadar, D.V.M., Ph.D., Martin Gabriel, M.D., Meike Pahlmann, Ph.D., Dennis Tappe, M.D., Jonas Schmidt-Chanasit, M.D., Benido Impouma, M.D., Abdoul Karim Diallo, M.D., Pierre Formenty, D.V.M., M.P.H., Michel Van Herp, M.D., M.P.H., and Stephan Günther, M.D.

April 16, 2014DOI: 10.1056/NEJMoa1404505

ABSTRACT

In March 2014, the World Health Organization was notified of an outbreak of a communicable disease characterized by fever, severe diarrhea, vomiting, and a high fatality rate in Guinea. Virologic investigation identified Zaire ebolavirus (EBOV) as the causative agent. Full-length genome sequencing and phylogenetic analysis showed that EBOV from Guinea forms a separate clade in relationship to the known EBOV strains from the Democratic Republic of Congo and Gabon. Epidemiologic investigation linked the laboratory-confirmed cases with the presumed first fatality of the outbreak in December 2013. This study demonstrates the emergence of a new EBOV strain in Guinea.

<BIG SNIP>

DISCUSSION

Phylogenetic analysis of the full-length sequences established a separate clade for the Guinean EBOV strain in sister relationship with other known EBOV strains. This suggests that the EBOV strain from Guinea has evolved in parallel with the strains from the Democratic Republic of Congo and Gabon from a recent ancestor and has not been introduced from the latter countries into Guinea. Potential reservoirs of EBOV, fruit bats of the species Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata, are present in large parts of West Africa.18 It is possible that EBOV has circulated undetected in this region for some time. The emergence of the virus in Guinea highlights the risk of EBOV outbreaks in the whole West African subregion.

(Continue . . .)

This morning the World Health Organization – via their twitter account – have been updating the situation.  You can monitor the conversation by following @WHO & @HaertlG (both Highly recommended to keep track of global health concerns).

Additionally, the World Health Organization has published a new, updated FAQ on the Ebola virus;

Frequently asked questions on Ebola virus disease

Published 15 April 2014

Download the FAQ on Ebola in pdf, 185kb

 

And lastly, I would note that Crawford Kilian over at Crofsblog has done a terrific job covering the flood of news reports coming out of West Africa on this outbreak. 

KSA: Public Health Messaging On MERS

 

Credit KSA MOH

 

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In my last blog (see MERS-CoV: The Twitter Of Their Discontent) I wrote about some of the dubious medical advice being purveyed by Arabic newspapers and on Twitter for dealing with the MERS Coronavirus.  Luckily, more reasoned public health advice is being promoted as well.

An example comes from a widely tweeted link to the following SAAID.net story.

 

8 important questions of Corona

Dr. Mohammed Al-Filali
Doctor in public health and preventive medicine @mh_filali

Dr. Osama barshid
Doctor in public health and preventive medicine @DrOsamah1

In the name of God the merciful

With increasing cases of Corona recently spread messages about the disease and its treatment and other. To minimize rumors and disseminate correct information about the disease we have group of physicians to answer some important questions about the disease to raise awareness in society.

First: what are the symptoms of the disease?

Most of the cases these symptoms appeared

- High temperature.
- Cough (cough).
- Shortness of breath.
- Symptoms such as sneezing, nominated or cold and runny nose.

Secondly: what do I do if these symptoms?

- Visit the health center or family doctor.
- The antihypertensive and painkillers, according to the doctor's instructions.
- A lot of liquids.
- Take enough rest.
- Avoid mixing with other people, especially children, the elderly or those with chronic symptoms.

Third: when to go to emergency?

- If symptoms are intensified.
- Or if the victim's age or suffering from chronic diseases or have low immunity.
- Or if there is contact with a person infected or suspected of infection during the two weeks preceding the onset of symptoms.

IV: what is the treatment?

- Not discover the cure for this disease, which is treating the symptoms and provide nutrients and supportive therapies to reduce complications.

VA: what are the health message across about as garlic as a remedy?

- Nothing proves the effectiveness of garlic as a cure for this disease. If there is proof of the effectiveness of garlic as an antibiotic relative to a specific type of bacteria, the metastatic disease is a viral disease and viral infections are treated with antibiotics.
But we can say that garlic in General may benefit like other natural substances such as honey, black seed in lifting the immunity, but is by no means a cure for the disease.

VI: is a dangerous and deadly disease?

- From the beginning of the discovery of the disease two years ago in April 2012 and March 27, 2014 were 206 cases in the world occurred in 86 of them or rough (42%), most deaths were in the elderly and patients with chronic diseases.

- There may be fewer deaths if there are cases of Corona light did not require testing and treatment.

7. How do I protect myself and around me from disease?

1) there is not a vaccine (immunization) specific to the disease, but can take the seasonal flu vaccination to prevent God from other types of influenza a swine flu (H1N1) and others.

2) Avoid contact with beauty and away from places and should make sure the boiling wetvoir camel milk if drinking it, and cook meat well before eating. Because the studies suggesting a link between HIV and beauty as a vector of disease.

3) It is also advised to take preventive measures for any disease is contagious and I am are as follows:

- Wash hands with SOAP and water or sterilizers.
- Avoid touching eyes, nose and mouth before washing.
- Avoid shaking hands or sitting patients.
- Cover your mouth with a tissue when you cough or sneeze with direct disposal of the handkerchief.
- Wear masks when mixing in large concentrations.

4) Cooperation with the Ministry of health in case samples or information from persons or contacts them to study and learn more about its properties.

5) Immunization and adhkaar in this period and in a while.

8. do you avoid going to hospital?

- When you need to visit the doctor advised to visit health centers and go to the hospital emergency where critical situations only.

Finally we ask God for a speedy recovery for each patient, mercy and forgiveness of the dead and to protect us and loved ones and everyone from all evil.

References:
-American Center for prevention of diseases (CDC)
-World Health Organization (WHO)
-Ministry of health

 

 

With a growing number of mild and/or asymptomatic infections being reported among known contacts of infected persons, the obvious trade-off with telling people with `mild or moderate symptoms’  not to go to the hospital is that community cases of MERS infection may not be as easily detected, or infected patients isolated.

 

It is likely, of course, that some mild or asymptomatic cases have been missed all along. 

 

While not ideal --the alternative – having thousands of worried well, along with some mildly ill patients show up at ERs around the nation could easily overwhelm and disrupt emergency medical services.

 

Not only for those worried about their coronavirus status, but for every other medical emergency as well.

 

One can only hope that doctors and health clinics are being instructed to refer the vast majority of suspected cases for further testing.

Hong Kong’s H7N9 Hygiene Messaging

All photos credit Hong Kong’s CHP

 

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Among the scores of publications produced by Hong Kong’s Centre for Health Protection (CHP) each year is their semi-annual (Jan/July) glossy PDF magazine called the CHP Newsletter.

 

The latest edition (CHP newsletter Issue No.33 (July 2013) ( 6.02 MB)) features a cover story on tuberculosis, a feature article on Hypertension, and then spends considerable time looking at two recent CHP emergency drills –`Exercise Ruby’ which concerned a response to MERS-CoV and `Exercise Amber’ which tested their response to a novel flu outbreak.

 

Hong Kong was hit particularly hard by SARS in 2003. Between March 11th and June 6th of that year a total of 1750 cases were identified, and of those, 286 died.  So Hong Kong authorities are exceptionally proactive when it comes to protecting the city from infectious disease threats.

 

A brief excerpt from the `Amber’ exercise follows:

 

The Exercise aimed at testing the response actions against the locally acquired ‘novel influenza infection’ (simulated) of a Hong Kong citizen, with emphasis on the escalation of the response level in accordance with the risk to the community. The scenario of the exercise was: ‘Emergency’ level response was activated in Hong Kong in times of a novel influenza that had been identified initially in overseas countries recently; 300 such local cases were found and 40 fatalities
were caused.

 

Another feature of this 16-page newsletter is a look at Hong Kong’s public health messaging on preventing the spread of H7N9.

 

Hand hygiene messages are ubiquitous in the city, appearing on billboards, the sides of busses, and in posters in shop windows.

 

PSAs (or what they call APIs – announcement of public interest) abound as well.  Below is an excerpt from the article on how the CHP is leveraging social media and new technologies to get the message out.

 

Two Announcements of Public Interest (APIs) were re-launched for disseminating the health message to the public. The APIs are not only broadcast through electronic media, including television and radio, but
also through the video systems on MTR, buses, minibuses, and even government and commercial buildings.

In view of the rising popularity of smartphones and tablet PCs, CHEU has launched an animated version of the two posters on the Yahoo! Homepage in late April. Both animated ads were also shown on MTR’s digital panel network.

Moreover, health messages on avian influenza were disseminated through non-conventional channels such as newspapers’ mobile applications. With our extensive coverage via different channels, we hope the health messages can reach the members of public and raise their awareness of avian influenza.

 

 

Hong Kong’s CHP continues to impress with not only their extensive public health messaging, but with their proactive exercises and drills and their openness in discussing surveillance and testing with the public for all manner infectious disease threats.

 

Once can’t help but wonder how much further along the world would be in combating emerging infectious disease threats if all other public health agencies around the globe were even half this diligent and forthcoming.

The Pandemic Preparedness Messaging Dilemma

 

Basic Preps: Emergency Weather Radio, First Aid Kit, Battery Lantern, Water storage

 

 

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National Preparedness Month (September) is just over a month away, and along with thousands of others across the country, AFD blog is once again proud to be part of this year’s NPM coalition.

 

FEMA and Ready.gov (along with many other state and federal agencies) urge personal, family, business, and community preparedness for all types of natural or man-made disasters, because they know that these events can and will happen.

 

We’re not talking about adopting a Ramboesque `doomsday prepper’ mentality here, but rather a rational and proportional response to genuine – if not entirely predictable – threats (see NPM12: Everyday Preppers).

 

Local, state, and federal officials know that during and following a disaster (hurricane, tornado, flood, earthquake) their ability to respond – particularly during the first 72 hours – may be limited. 

 

They also know that essential services - like electrical power, 911 service, and running potable water - could be out in some communities for days or even weeks.  

 

Which makes having minimum preps (at least 3 days of food & water, first aid supplies, flashlights & lanterns, an NWS emergency radio, and a workable emergency plan) essential for every family and business.

 

Of+ course, 3 days is a minimum recommendation.

Most emergency managers would concede that having more (say, a week or 10 days) would be preferable (see When 72 Hours Isn’t Enough).

 

The County of Los Angeles Emergency Survival Guide calls for having 3 to 10 days worth of food and water. The L.A. guide may be downloaded here (6.5 Mbyte PDF). 

 

And the HHS has historically called for `at least’  2-weeks worth of preps for families to deal with a serious pandemic.

 

But in these tough economic times, telling families and businesses they should prep for 3 days is difficult enough - if agencies set the preparedness bar too high they fear it would discourage some from trying at all.

 

While natural disasters (like earthquakes, hurricanes & floods) are a perennial threat, we are also watching two newly emerging viruses (MERS-CoV & H7N9) – along with H5N1 -  that all appear to have some degree of pandemic potential.

 

And that brings up the old problem of how do we talk (rationally and effectively) about pandemic preparedness – particularly in these difficult economic times - when we can’t know with any certainty that a pandemic is really in the offing?

 

I confess this has been a frequent topic of conversation here in backchannels of Flublogia, and is something that Sharon Sanders of FluTrackers and I wrestle with almost daily.

 

We are both sensitive to the fact that many people are simply not in a position to make extensive preparations, yet we know the more people in a community who are prepared, the better able that community will be to deal with any disaster.

 

Like this blog, FluTrackers promotes an `All Hazards’ preparedness stance.

 

`We believe in the "all disaster" methodology in preparedness. If everyone is prepared for the typical natural disaster threats in their local areas this will be an effective preparation for any infectious disease outbreak.’ – Sharon Sanders.

 

We both stress the importance of creating a good support system among family and friends (see In An Emergency, Who Has Your Back?) and strongly support the AMA’s advice for those with prescription medicine needs to store enough extra to see them through a disaster scenario (see AMA press release PERSONAL MEDICATION SUPPLY IN TIMES OF DISASTER).

 

Back in 2006-2007 many people promoted the idea of having up to 3 months of supplies on hand, including a high profile article in The Medical Journal of Australia called A food “lifeboat”: food and nutrition considerations in the event of a pandemic or other catastrophe.

But for most people this just isn’t practical, and is probably overkill anyway.

 

But a pandemic could cause you and your family to need (or desperately want) to stay home for two weeks or longer, and to do that you would need to have adequate supplies on hand.

 

While much of the pandemic preparedness messaging developed by the HHS between 2005 and 2008 is no longer online, flu.gov still maintains a pandemic planning and preparedness page, where the following appears.

 

 

Their advice (and this is for before a pandemic threat becomes imminent).

 

 

While these (and other) pandemic preparedness documents are available on the Flu.gov  website, and the CDC has been busily issuing interim pandemic guidance to the healthcare community (see CDC: Pandemic Planning Tips For Public Health Officials, H7N9 Preparedness: What The CDC Is Doing), so far there has been very little messaging directed to the general public.

 

I’m certain there is (quite understandable) concern over being perceived as `crying wolf’ again, after the huge build up the HHS gave H5N1 between 2006 and 2008, which still hasn’t produced a pandemic.

 

But of course, the H5N1 story hasn’t been completely written yet, either. 

 

As I said, it’s a dilemma. And I don’t suggest that there are any easy, or obvious answers. 

 

While the odds that we will see a severe pandemic in the near term are probably low (not that anyone really knows), they probably are no more remote than our seeing an 8.0+ earthquake or a CAT 5 hurricane strike a large American city during the same time frame.

 

Threats that are openly discussed and prepared for each and every year (see NPM12: A Whole Lotta Shakeouts Going On & Hurricane Preparedness Week: Day 6 & 7).

 

 

Perhaps there’s something about a pandemic scenario which seems more `real’ and personal than these other disasters, and therefore more difficult to discuss and plan for. After all, it took more than 80 years and the publication of John Barry’s book The Great Influenza, before the Spanish Flu of 1918 re-entered the American conversation.

 

But difficult or not, the pandemic threat needs to considered seriously, and put at least on an equal footing with the other `hazards’ we encourage the public and the business community to prepare for.

 

Not because it is an easy dialog to hold, but because by the time we know a pandemic is truly on the way, it will be well past time to have started that conversation.

 

For far more expert commentary on pandemic preparedness and crisis communications than I can provide, I’d invite you to visit The Peter M. Sandman Risk Communication Website where Dr. Sandman and Dr. Jody Lanard explore these issues often, most recently in:

 

Pandemic preparedness and pandemic stages re H5N1, H7N9, and MERS

 

 

And for those interested, some of my recent pandemic preparedness essays include:

 

The Great Mask Debate Revisited

Pandemic Planning For Business

Practice, Practice, Practice