Infectious Disease in the News Pt. II: Enterovirus D68

Enteroviruses are single-stranded RNA viruses that commonly cause disease in the warmer months of the year.  Some of the better known enteroviruses include polio, Coxsackie A and B, and echovirus.  They can be found in the respiratory secretions and stool of an infected person.   Most infections with non-polio enteroviruses are asymptomatic or cause a brief febrile illness, but some have been associated with pleurodynia (inflammation  of the lining of the lung), myopericarditis (inflammation of the lining of the heart), acute hemorrhagic conjunctivitis, aseptic (non-bacterial) meningitis, encephalitis, herpangina (painful mouth blisters), and hand-foot-and-mouth disease.

Enterovirus D68 is one of more than 100 non-polio enteroviruses.  First identified in California in 1962, the virus caused sporadic illness similar to the common cold until August 2014 when cases of severe respiratory disease in children were diagnosed in the Midwest.  Since that time, cases have been reported from 43 states, the District of Columbia, and Canada.  Some have required hospitalization and respiratory support.  Children with asthma appear to be at increased risk for more severe respiratory illness.  There have also been reports of associated polio-like paralysis though this is less definitive. No antiviral medications are available to treat enteroviruses, and there are no vaccines to prevent disease (other than polio vaccine).

Like other respiratory viruses, D68 spreads from person to person through coughing, sneezing, or touching a surface previously touched by an infected person.  So, the best way to protect yourself and prevent spread is through good personal hygiene – hand-washing, avoiding touching your eyes, nose and mouth, not sharing cups or eating utensils, disinfecting commonly used surfaces, and covering coughs and sneezes with a tissue.

Resources:

Enterovirius D68 CDC Information page 

What Parents Need to Know (Healthy Children.org) 

Hand Washing: A Powerful Antidote to Illness (Healthy Children.org) 

A Closer look at Gender Pay Inequality

The American Association of University Women (AAUW) recently released their fall 2014 report "The Simple Truth About the Gender Pay Gap" that gives a great overview of pay inequality in America based on gender. The report looks closely at differences by race, specific occupations and within all 50 states. It also addresses common misconceptions about why this gap exists. Most importantly, it addresses how this often overlooked problem effects women and their families and why it is something that needs to be addressed, especially in light of the Paycheck Fairness act being blocked by the senate this past September. For many women equal pay could mean better life for themselves and their families, as higher income is associated with lower stress, greater autonomy and better overall health. Everyone has something to gain if we can get rid of the gender gap.

Resources: 
AAUW Gender Gap Summary Page

The Simple Truth About the Gender Pay Gap - Full Report 

More Protection From Ebola for Hospital Staff

Adding to our post from yesterday,  news has been circulating evaluating how hospitals are handling Ebola  and the risks it can pose to staff. Particularly, nurses have began to speak out ever since the Dallas nurse who was recently diagnosed Ebola (After treating the first patient in the U.S. to develop the disease)  was said to have contracted it through a "breach in protocol". Now, many are speaking out about the protocol in their own hospitals to spread awareness and cause change.  The article Ebola–RNs Call for Highest Standards for Protective Equipment, including Hazmat Suits and Training gives insight into what nurses are reporting across the country. It is hopeful as healthcare providers take a stand, both the hospitals and those in policy will work to make the handling of infectious diseases safer for both patients and the workers providing their care. 

Infectious Disease in the News Pt. I: Ebola

Ebola is caused by infection with one of five filovirus strains, a type of single-stranded RNA virus.  It can be transmitted to people from wild animals and further spreads via human-to-human transmission, causing severe, often fatal disease in humans and non-human primates.  Although its natural reservoir is unknown, fruit bats have been implicated. 

Ebola was first discovered in 1976 near the Ebola River in the Democratic Republic of the Congo. Over the years, sporadic outbreaks have occurred in remote African villages.  The current outbreak was first reported in March 2014.  It is the largest in history, involving both rural and urban areas in multiple countries in West Africa, and has been designated the first Ebola epidemic the world has ever known. Human-to-human transmission occurs via direct contact (through broken skin or mucous membranes) with blood, and other bodily fluids (e.g. saliva, stool, semen, breast milk) of infected people.  Contaminated surfaces and materials such as clothing and bedding also serve as sources of infection.     

Previously known as Ebola hemorrhagic fever because of the internal and external bleeding that can occur, the illness has an incubation period between exposure and the onset of clinical illness that ranges from 2-21 days.  Humans are not infectious until they develop symptoms which typically mimic a flu-like illness with the sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases bleeding.  Leukopenia (low white blood cell counts), thrombocytopenia (low platelet counts), and elevated liver enzymes can be seen.   A definitive diagnosis can be made using specialized testing of blood samples (e.g. ELISA, RT-PCR, electron microscopy or cell culture) under maximum biological containment conditions. 

The average case fatality rate is ~50%, though can be as high as 90%.   There are no specific, proven therapies or vaccines for Ebola, though several health workers have been treated with ZMapp, an investigational product comprised of three humanized monoclonal antibodies.  There is also interest in empirically transfusing convalescent whole blood or plasma from patients who have recovered to patients with early Ebola disease.  Supportive care may improve survival, but this unfortunately is lacking in many African countries.  Gowns, gloves, masks and goggles or face shields should be worn by healthcare personnel and family members caring for ill patients, and hand washing should occur often. These have also been in short supply in Africa and strict infection control practices have been lacking. 

Current CDC recommendations for individuals who may have had contact with ill patients include isolation (staying at home and avoiding public contact) and monitoring daily temperatures and symptoms for 21 days to detect any potential illness as quickly as possible.  

Resources: 

CDC Ebola information page

Tis' the (Flu) Season! - Facts about the Flu and Dispelled Myths

Every September when we think about “back to school” season, we should also think about another season just around the corner - flu season.  Many people shrug off getting vaccinated against the flu with a variety of excuses like: “I never get the flu”, “the flu is just like a bad cold” or “I’d rather get the flu than get a flu shot which GIVES me the flu”.  So, let’s dispel some of these misconceptions.

How Dangerous is Influenza?

The flu is not just another cold.  In addition to making you feel absolutely miserable for days with fever, congestion, cough and body aches, it is far more dangerous than the common cold or other circulating upper respiratory infections.  Each year approximately 200,000 people in the U.S. are hospitalized due to influenza, and up to 49,000 die.  Compare that to the annual mortality from breast cancer (~40,000) or AIDS (~19,000) in the United States.  Although morbidity and mortality are generally highest among young children and adults over age 65, last year, 60% of hospitalizations occurred among adults between the ages of 18 and 64 – those who had vaccination rates of only 37%.    

When is Flu Season?

Flu seasons are unpredictable and vary from year to year in terms of timing, severity, and length.  Although influenza activity most commonly peaks in the U.S. between December and February, some years have seen cases begin as early as October and continue as late as May.

How is Flu Spread?

Influenza is spread by droplets up to 6 feet away through coughing, sneezing or talking. You can also get the flu by touching a surface or object that has flu virus on it and then touching your mouth or nose.  Most people know they can get the flu from patients and coworkers who are sick, but don’t realize they can spread it to others even if they don’t feel sick.  Most healthy adults can infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick.  Approximately 20% to 30% of people carrying the influenza virus have no symptoms.

Who Should Get Vaccinated?

CDC recommends a yearly flu vaccine(http://www.cdc.gov/flu/protect/vaccine/index.htm) for everyone 6 months of age and older, preferably by October, since it takes about two weeks after vaccination for an immune response to develop. 

Individuals at particularly high risk for influenza include:

• Children younger than 5 (especially those younger than 2 years of age)

•Adults 65 and older

•Pregnant women

•People with chronic health issues like asthma, diabetes, heart disease, cancer and HIV/AIDS.

Dispelling the Myths

“The flu vaccine can give you the flu”

Injectable flu vaccines contain inactivated, non-infectious virus particles.  Although the nasal spray vaccine does contains live flu virus, it is attenuated (weakened) in such a way to be able to stimulate immunity without causing illness.  People not only mistake the side effects of the vaccine for the flu but also erroneously attribute illness with other unrelated cold viruses to the flu. 

“I can take antibiotics if I get the flu”

Antibiotics only treat bacterial infections – not the influenza virus.  Although there are antiviral medications against the flu, to be effective in reducing the duration and severity of illness, they must be taken within 48 hours of the beginning of symptoms. 

“I don't need to get a flu shot every year”

Influenza viruses are constantly changing (mutating), so each year flu vaccines are updated to protect against the most common circulating viruses.  Although protection from the vaccine decreases over time, protection typically lasts about a year.

“Pregnant women should not get a flu shot”

Pregnant women and their offspring are at very high risk for complications from the flu.  Pregnant women are 7 times more likely to be hospitalized than non-pregnant women and account for 5% of all flu-related deaths.  All pregnant women should to be vaccinated with inactivated flu vaccine.   

“Getting the flu vaccination is all I need to do to protect myself from the flu.”

Besides vaccination, avoid contact with people who have the flu and wash your hands frequently!

Bottom Line

By getting vaccinated and practicing good personal hygiene, you not only help to protect yourself, but your family, friends and patients.