AuthorTopic: CDC director warns that Congo’s Ebola outbreak may not be containable  (Read 63 times)

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CDC director warns that Congo’s Ebola outbreak may not be containable



A Congolese health worker administers Ebola vaccine to a boy who had contact with an Ebola patient in the village of Mangina, in North Kivu province, on Aug. 18. (Olivia Acland/Reuters)

Centers for Disease Control and Prevention Director Robert Redfield said Monday that the Ebola outbreak in conflict-ridden Congo has become so serious that international public health experts need to consider the possibility that it cannot be brought under control and instead will become entrenched.

If that happened, it would be the first time since the deadly viral disease was first identified in 1976 that an Ebola outbreak led to the persistent presence of the disease. In all previous outbreaks, most of which took place in remote areas, the disease was contained before it spread widely. The current outbreak is entering its fourth month, with nearly 300 cases, including 186 deaths.

If Ebola becomes endemic in substantial areas of North Kivu province, in northeastern Congo, “this will mean that we’ve lost the ability to trace contacts, stop transmission chains and contain the outbreak,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security, which hosted the briefing on Capitol Hill that featured the Ebola discussion with Redfield.

In that scenario, there would be a sustained and unpredictable spread of the deadly virus, with major implications for travel and trade, he said, noting that there are 6 million people in North Kivu. By comparison, the entire population of Liberia, one of the hardest-hit countries during the West Africa Ebola epidemic of 2014-2016, is about 4.8 million.

The outbreak is taking place in a part of Congo that is an active war zone. Dozens of armed militias operate in the area, attacking government outposts and civilians, complicating the work of Ebola response teams and putting their security at risk. Violence has escalated in recent weeks, severely hampering the response. The daily rate of new Ebola cases more than doubled in early October. In addition, there is community resistance and deep mistrust of the government.

Some sick people have refused to go to treatment centers, health-care workers are still being infected, and some people are dying of Ebola or spreading the virus to new areas. An estimated 60 to 80 percent of new confirmed cases have no known epidemiological link to prior cases, making it very difficult for responders to track cases and stop transmission. In late August, the United States withdrew some of the CDC’s most seasoned Ebola experts who had been stationed in Beni, the province’s urban epicenter, because of security risks.

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“I do think this is one of the challenges we’ll have to see, whether we’re able to contain, control and end the current outbreak with the current security situation, or do we move into the idea that this becomes more of an endemic Ebola outbreak in this region, which we’ve never really confronted,” Redfield said.

If that happens, health-care responders may need to consider vaccinating broader populations instead of the current strategy of vaccinating those who have been in contact with infected people.

When contact tracing begins to fall apart, “then you are entering another phase and losing the hope that you can arrest the outbreak through standard interventions,” J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, said in an interview. In a new report, Morrison wrote that there is an urgent need for “high-level political attention focused on generating an updated game plan” to improve security, train and deploy community health workers, and win community trust.

“This is going to be a complicated and deeply problematic situation and we need to prepare ourselves for dealing with this long term,” Morrison said.

Redfield, officials from the World Health Organization and other experts say one of the biggest worries is the spread within Congo to places like Butembo, a major trading port and urban area, where the risk of widespread transmission escalates dramatically.

In mid-October, the World Health Organization said that it was “deeply concerned” by the outbreak but that the situation did not yet warrant being declared a global emergency. The U.N. health agency called for response activities to be “intensified.” The WHO’s director general, Tedros Adhanom Ghebreyesus, and a top U.N. official for peacekeeping operations, are in Congo this week to take stock of the response.

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"It is difficult to write a paradiso when all the superficial indications are that you ought to write an apocalypse." -Ezra Pound

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To Every Pathogen There Is a Season
« Reply #1 on: November 11, 2018, 06:43:37 AM »
To Every Pathogen There Is a Season
Infectious Diseases affect us like clockwork, although it’s not clear why


To Every Pathogen There Is a Season

Everyone knows flu strikes most often during wintertime, but new research indicates a number of other infectious diseases are seasonal, too. Chicken pox often peaks in spring. Sexually transmitted diseases tend to strike most often in the summer, at least in the U.S. And bacterial pneumonia is most common in midwinter, according to a study of 69 infectious diseases, published Thursday in PLOS Pathogens.

Lead author Micaela Elvira Martinez says she had expected to find acute infections, ranging from malaria to polio, had seasonal peaks. What she had not anticipated was a similar pattern in chronic ones—including HIV. “I was very surprised,” says Martinez, an assistant professor at Columbia University’s Mailman School of Public Health.

Following the calendar makes perfect sense for mosquito-borne diseases such as West Nile virus, says David Fisman, a professor of epidemiology at the University of Toronto’s Dalla Lana School of Public Health. Toronto, where he lives, is too cold for mosquitoes most of the year, and the disease cannot spread if the insect is not around. But Fisman, who was not involved in the new research, says it is not as obvious why respiratory and gastrointestinal bugs would have a seasonality. “Characterizing them as seasonal is the first step,” he says. “The hard part is: Why on earth are they seasonal?”

The reasons generally vary by disease. Middle East respiratory syndrome (MERS), a dangerous respiratory virus linked to camels, is more often reported during camel calving season, according to the new study. Triggers can also be pegged to socioeconomics and geography. In developed countries measles outbreaks tend to spike during the school year, when children are in close contact; in developing areas outbreaks may be tied more to agricultural cycles, the study says.

Less well-understood is why cases of polio seemed to peak in the late summer in the U.S.—so much so that scientists once investigated whether the illness was caused by ice cream. Similar viruses including enterovirus D68 also seem more common in late summer and early fall, which might explain the recent spike in cases of acute flaccid myelitis—a rare, poliolike condition that can follow infection by EV-D68.

Other researchers have talked about the seasonality of certain diseases, but Martinez may be the first to survey such a wide range of conditions and find this common thread. Previous studies tended to focus on the seasonality of one or two conditions, and it was not possible until recently, Martinez says, to amass the kind of data that allowed her analysis. Her research involved reviewing previous studies of 69 communicable diseases of public health interest as presented on the Web sites of the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and the European Center for Disease Prevention and Control. She then used Google scholar to systematically search for information about disease seasonality.

Recognizing such disease patterns can boost the fight against them, says Elena Naumova, chair of the Division of Nutrition Data at Tufts University. Naumova, who was not involved in the new study, says this kind of disease calendar could be useful for issuing travel advisories or handing out bed nets to protect against mosquitoes.

The findings about the cyclical nature of many illnesses, Martinez says, also suggest people with chronic diseases might benefit from more frequent checkups or a higher dose of their medication at certain times of year to prevent flare-ups.Understanding this periodicity could also help scientists improve other strategies for fighting illnesses. Before switching to human disease Martinez researched infections in marine mammals; scientists researching such animals worry species are most vulnerable when their population levels are at an annual low point, she notes. Turning that around, perhaps a pathogen could be most effectively attacked at a time of year when its population is relatively small, in order to head off a later, larger outbreak. “I see it as biology that’s right in front of our faces, that we overlook very often,” she says.

Researchers next need to examine in more detail how this calendar varies around the world and whether it is affected by climate change, Naumova says. She is concerned climate-induced changes might drive diseases with different schedules closer together, making them more dangerous—just as HIV becomes more serious if the patient also contracts malaria or tuberculosis.

The new study’s findings also suggest humans are more tied to our natural surroundings than we usually acknowledge, Naumova and Martinez say. Animals that transmit infectious diseases to us often have seasonal peaks and troughs of transmission, a fact that likely interacts with variations in our own immunity.

According to Martinez, fields such as psychology are far ahead of infectious disease experts in understanding the human body changes cyclically over time. The type of depression known as seasonal affective disorder, for example, sets in when light levels dim in fall and then lifts when the world brightens in spring. It makes sense that such mood fluctuations could also trigger biological changes that may affect the immune system, she says. Perhaps that is one reason even chronic diseases can impact us like clockwork.

"It is difficult to write a paradiso when all the superficial indications are that you ought to write an apocalypse." -Ezra Pound

 

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