Posts Tagged ‘World Health Organization’

First Case of MERS in U.S.

May 2nd, 2014

MERS-CoV picA healthcare worker who recently returned from Saudi Arabia is the first confirmed case of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in the U.S.  The person’s in stable condition in isolation in an Indiana hospital.

All public health agencies around the world have been carefully watching for new cases of MERS since the disease was discovered in Saudi Arabia in 2012. There’ve been 401 cases, 93 have died.

CDC’s not releasing a lot of information about the first case, except to say the patient was providing healthcare in Saudi Arabia and started experiencing severe respiratory symptoms after returning to the states.  Based on the patient’s symptoms and travel history, the hospital sent a sample to the Indiana state lab, where it tested positive for MERS-CoV.  Today, the CDC confirmed the positive result. We can do this testing at our state lab too.

The virus causes severe respiratory symptoms like fever, cough, and shortness of breath. The virus has spread person-to-person among family members and close contacts… but there hasn’t been any sustained transmission.  The CDC and others are working together to track down all people who have been in contact with this patient.  At this point, no other cases have been detected.

Ebola

March 31st, 2014

ebolaIf you’re like me, your introduction to Ebola virus came in the 1990s with the bestseller nonfiction thriller The Hot Zone and loosely-based film Outbreak.  The descriptions of a deadly hemorrhagic fever that quickly spread through the population were terrifying, as were the life-threatening dangers posed to the intervening infectious disease personnel.

The Guinea Ministry of Health has a total of 103 suspect and confirmed cases with 66 deaths.  They announced today that the disease has spread to the capital, Conakry.  Also, reports of suspected cases in neighboring countries are being investigated: Liberia reported to the WHO 8 suspected cases, including 6 deaths, in individuals with recent travel history to Guinea. Sierra Leone has reported 6 suspected cases, including 5 deaths.

Bats appear to be a reservoir and hosts for the ebolavirus. Initial infections in humans result from contact with an infected bat or other wild animal. Ebola spreads by contact with other patients’ infectious secretions and from consuming the meat of infected animals.  For Guinea’s particular strain, the fatality rate is nearly 90%, and is heralded by fevers and internal bleeding.   Doctors Without Borders and WHO both have teams in Guinea, working with the Health Ministry to contain the spread.

In countries with weak medical infrastructures, an outbreak like this can be devastating.  Historically, countries with poorer infrastructures and health status suffer far worse than more bolstered nations.  So while Arizona is under no threat from Ebola, maintenance of a strong public health and emergency preparedness program remains a top priority.

Tuberculosis & Mankind

March 24th, 2014

Tuberculosis and mankind share a dramatic and intertwined history.  TB has caused millions of deaths every year for centuries, been found in Egyptian mummies, has placed patients into sanatoriums, and has  even has a folklore link relating it with vampires,  The drama continues into this decade: in 2012, there were 8.8 million new cases of TB diagnosed worldwide and around 1.2 million deaths. 

Public health departments have been fighting for TB elimination since their creation.  Efforts in the 1950s decreased mortality by nearly 90%, but a resurgence in cases and deaths occurred after drug-resistant strains emerged in the ‘80s.  Soon after, the WHO declared TB a global health emergency, and the next decade saw TB control targets developed in an attempt to eliminate TB. 

Arizona continues to strive to hit these targets.  In 2013, there were 184 TB cases reported in the state, a 13% decrease from the year before.  Arizona also has a lower case rate compared to the nationwide average.  Our programs use “directly observed therapy”, evidence-based policies, and partnerships with counties and Cure TB to ensure patients are completing treatment and reducing their risk of developing drug-resistant TB

Our Arizona State Public Health Laboratory also supports TB control.  In 2013, we adopted the Cepheid GeneXpert, a test that detects TB in only 2 hours while identifying mutations associated with drug-resistant TB.  Specimens found to have these mutations are forwarded to the CDC for a full battery of molecular tests to confirm drug resistance. 

World TB Day is coming up on March 24th, which is commemorated annually to bring global awareness about the effects of TB.  You can join us for a Twitter Chat at 10 a.m., March 24, 2014 to discuss TB in Arizona.  Follow us on Twitter and follow the chat using #azhealthchat.

2014-2015 Influenza Vaccine Recommendation

March 20th, 2014

Every year the World Health Organization holds a meeting with worldwide experts to make recommendations for the next season’s Northern Hemisphere flu vaccine. It seems strange to plan for next season when we’re still in the midst of the current flu season, but the vaccine-making process still takes about 6 months. Influenza season generally ramps up around September or October, so starting the process now ensures that there’ll be a good supply of vaccine for folks to get protected from flu before the next season hits. 

At last week’s meeting in Geneva, the WHO panel recommended that the components in next season’s vaccine remain the same as this year’s. Even though the vaccine components will stay the same, it’s still important to get vaccinated every year. Immunity wanes over time, so the best way to protect yourself is to get vaccinated every year.

 

Dogs & River Blindness

October 1st, 2013

Last year a young child came down with onchocerciasis in northern Arizona.  Onchocerciasis, is caused by a filarial worm similar to dog heartworm and the roundworm that causes elephantiasis.  This child had a dog-related species (Onchocerca lupi) of the roundworm in her neck next to her spinal cord and was the first documented case in the US. A few other cases of this species has been found in dogs and cats in the US and about four other human cases in other parts of the world but where they got the infection and how they were infected is still unknown. 

Onchocerciasis, is also the second leading infectious cause of blindness in the world and can cause debilitating and disfiguring skin disease.  The human species of this parasitic worm (Onchocerca volvulus), is spread by the bite of an infected blackfly. It got the name “River Blindness” because the fly that transmits infection breeds in rapidly flowing streams and the resulting infection can cause blindness. Persons with heavy infections will often have a skin rash (usually itchy), eye disease, or nodules under the skin. The World Health Organization’s estimates that at least 25 million people are infected and 123 million people live in areas that put them at risk of infection. About 300,000 people are blind because of the parasite and another 800,000 have visual impairment. Nearly all of the infected persons live in Africa; with about 1% in Yemen and six countries in the Americas. 

The infection is transmitted in remote rural areas and, unlike malaria, an infection often requires more than one infectious bite. So the risk of infection is higher in adventure travelers, missionaries, and Peace Corps volunteers and other long-term volunteers who are likely to have repeated exposures to blackfly bites. There is a lower chance of transmission in the Americas, even for those with longer stays. 

The disease spreads from person to person by the bite of a blackfly, but the larva must undergo a change in the fly. When a blackfly bites a person who has onchocerciasis, tiny worm-like larva (called microfilaria) in the infected person’s skin enter and infect the blackfly.  After about 2 weeks, the larvae develop into a stage that is infectious to humans and make their way to the mouth of the fly.  Like mosquitoes, female blackflies feed on animal blood to make eggs.   An infectious blackfly will deposit larvae on the skin when biting a person. The larvae then penetrate the skin to infect the person.  The number of worms in a person is related to the number of infectious blackfly bites.  

It can take up to one year for the tiny larva (microfilaria) to develop into an adult worm and between 10 and 20 months before larvae can be found in the skin.  A nodule begins to form around the adult worms protecting it from the immune response.  Each adult female worm can live from 10-15 years, and produce thousands of larvae a day and millions of larvae during her lifetime.  It’s the dead and dying larvae that cause most of the symptoms of this disease, and most people feel well until the adults start producing large numbers of larvae.  The damage caused by larvae that die in the eye results in damage of the optic nerve or lesions on the cornea that without treatment, clouds the cornea resulting in blindness.  Blindness usually occurs with a heavier worm burden (an intense infection).

Filariasis

September 5th, 2013

I thought I’d do a series on some interesting tropical diseases over the next few weeks.  Let’s start with a disease called filariasis- which can cause something called elephantiasis. 

You’ve probably heard of a disease in dogs called heartworm.  It’s caused by tiny thread-like worms called microfilariae.  Like many diseases, there’s a similar disease that people living in Africa and Asia can get, called lymphatic filariasis.  As the name suggests, the microscopic worms infect the lymph system, damaging the body’s ability to control fluid balance and the immune system.  While most people show no symptoms of infection, a small percent of infected people develop swelling and fluid buildup. When this happens, the skin and tissue are more susceptible to germs and repeated infections.  If not kept clean and properly treated- the skin becomes hardened and thickened and in some cases making a person’s leg elephant-like. This physically and socially debilitating condition is called elephantiasis. 

The small worms that cause the disease are transmitted from an infected person by a mosquito bite.  The adult worms mate and release millions of these microfilariae into the blood system.  Coincidentally, the tiny worms tend to circulate in the blood at night, the time when mosquitoes are likely to bite and the best time to examine the blood of an infected person to make the diagnosis.  Once in the mosquito, the microfilariae develop into a larva form in a couple weeks and the mosquito can then infect the next person it bites. 

The WHO estimates over 120 million people are currently infected with lymphatic filariasis, with about 40 million disfigured and incapacitated by the disease. A further 1.4 billion people are at risk for this disease. About 65% of those infected live in South-East Asia, 30% in Africa, and the remainder in other tropical areas.   The good news is the United Nations Prequalification of Medicines Programme, managed by the WHO announced the prequalification of a medicine, diethylcarbamazine (DEC), to be used in preventive treatment campaigns, aimed at eliminating this disease.  When taken, this medicine eliminates the microfilariae in the blood so mosquitoes can’t get infected… meaning fewer people will become infected.

 

Camelus dromedarius & Our State Public Health Lab

August 16th, 2013

Last year, a new SARS-like virus called Middle East Respiratory Syndrome coronavirus (MERS-CoV) broke out in Saudi Arabia. Since then, 94 cases of the very lethal disease have been reported by the World Health Organization (50% of the cases have been fatal).  All the cases have been on the Arabian Peninsula.  The virus causes severe respiratory symptoms like fever, cough, and shortness of breath.  The virus has spread person-to-person among family members and close contacts…  but there hasn’t been any sustained transmission.  

Our Arizona State Public Health Laboratory passed all the requirements to test for the new virus under an Emergency Use Authorization from the FDA this week.  We received the CDC-developed assay test kit last week from the Laboratory Response Network…  so now we’re able to test any suspect patient samples in Arizona. 

Interestingly, a study published in The Lancet this week found that the virus is common among dromedary (one hump) camels on the Arabian Peninsula.  CDC, WHO, and other public health organizations are looking into all severe acute respiratory cases, especially those with recent travel to the region to find any new cases and learn more about how it might be spreading. 

Hopefully we won’t see any cases here in Arizona, but if any patients are suspected of having MERS-CoV because of their symptoms and travel history, our State Lab will now be able to verify or rule out the diagnosis quickly so epidemiologists at the state and county can prevent additional cases.  If you’re interested in learning more about MERS-CoV, here’s some up to date information.

 

SARS déjà vu?

May 11th, 2013

Last month the World Health Organization (WHO) began to receive reports of human cases with SARS-like infections caused by a new coronavirus. According to WHO, 30 cases of this new illness have been found and 60% of the infections have been fatal. So far, the cases have been limited to Saudi Arabia, Qatar, Jordan, the United Arab Emirates, the UK and France. Symptoms are pretty serious and include fever, cough and shortness of breath. Most of the people infected have required hospitalization. It looks like the virus spreads person to person, but scientists don’t yet know enough to say for sure.

CDC, WHO, and other public health organizations are looking into all severe acute respiratory cases, especially those with recent travel to the Arabian Peninsula to identify any new cases of the virus and learn more about how it might be spreading. No cases have been found in the US.  Here’s some up to date information if you’re interested in learning more.

Yesterday I blogged about what we’ve learned since we first discovered SARS. 

 

SARS… A 10-Year Retrospective

May 10th, 2013

This Spring marks 10 years since Severe Acute Respiratory Syndrome (SARS) arrived on the global public health scene.  It started as a mystery illness in SE Asia- without name, origin, or cure in February of 2003.  The CDC immediately began working with the World Health Organization to investigate the outbreak.  Public health scientists across the globe scrambled to understand and contain this health threat… which ultimately infected more than 8,000 people- killing about 10% of them. 

By March of 2003, the CDC had confirmed that the disease wasn’t caused by an influenza virus, but they didn’t know the culprit…  so they named it after the symptoms (Severe Acute Respiratory Syndrome) rather than the causative agent (it turned out to be a new Coronavirus).  March of ’03 also marked the time when the CDC figured out that the virus was spread via face-to-face human contact.  That’s also when the CDC and WHO recommended strict infection control measures including hand washing, gloves, avoiding sharing household items, and limiting interaction between ill patients and others. 

Exactly 10 years ago today CDC figured out that there were some “super-spreaders” that were a particular problem with the growing epidemic.  May ’03 also marked the month in which the investigation and public health and clinical interventions matured- bringing the full weight of the global public health and clinical management system to bear on the virus.  Interventions like concise case definitions and reporting standards, laboratory diagnostic tests, travel restrictions, and clear clinical management and infection control guidelines all worked together to eradicate the virus by the Summer of 2003. 

The forensic investigation continued for a few months after the virus was eradicated.  The investigation kept pointing toward an animal called a Civet as the source of the new Coronavirus.  A SARS-like virus had been isolated from civets captured in areas of China where the SARS outbreak originated and sold in live animal markets.  It’s a mammal with a catlike body, long legs, a long tail, and a masked face resembling a raccoon or weasel.  By January of ’04 it was pretty clear that a Civet was the probable source, and the CDC issued a  “Notice of Embargo of Civets”, which banned the importation of civets into the US. The ban is currently still in effect.  China also implemented some control measures on them. 

Interested in the whole story?  Check out “Remembering SARS: 10 Years Later” on the CDC’s website.

Next Season’s Influenza Vaccine

March 5th, 2013

Just as our influenza season winds down (and it is), it’s time to plan for the next one.  Every February the World Health Organization convenes a panel of experts to look at the most current data on the circulating flu strains from around the world and makes recommendations for the next season’s Northern Hemisphere flu vaccine.  At this week’s meeting in Geneva, the group recommended changing a B component of the vaccine, but sticking with the A/H3N2 and A/H1N1 components for next year. 

It may seem too early to be thinking about next year’s flu vaccine, but planning in February allows time for vaccine companies to grow the viruses and process the vaccine. The vaccine-making process still takes about 6 months… so it’s important to start as early as possible to ensure that vaccine is available for the start of the next flu season. Getting vaccinated against the flu every year is important, especially because the vaccine strains can change from year to year, as will happen for the 2013-2014 season.