By: Elisavet Serti, Ph.D.
Ebola and Public Health
After Ebola devastation, a measles outbreak threatens West Africa
A second health crisis, after the most widespread Ebola epidemic in history, is threatening thousands of people in West Africa. The Ebola crisis has devastated public health systems and, as a result, has slowed down measles immunizations, a viral lethal disease that could affect the region even worse than Ebola. Even before Ebola hit, only an estimated 62% to 79% of children were vaccinated against measles in Liberia, Guinea, and Sierra in 2012 and 2013, according to the Demographic and Health Surveys — and that was with only one dose of the vaccine. Because the virus is so exquisitely transmissible, 95% of the population must be protected with two doses of vaccine to stop measles. “The secondary effects of Ebola are likely to be as bad as or worse than the direct effects,” says epidemiologist Justin Lessler of Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who with his collaborators warned about a potential post-Ebola measles outbreak.
The symptoms of measles generally appear about seven to 14 days after a person is infected and include fever, runny nose, cough, red eyes, and sore throat, followed by a rash that spreads over the body. The measles virus is highly contagious and spreads through the air through coughing and sneezing. Common measles complications include ear infections and diarrhea but some people may suffer from severe complications, such as pneumonia and encephalitis that could be lethal. In the United States, as many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. Encephalitis is less common (1 out every 1000 children), which can leave the child deaf, or with intellectual disability. Measles is characterized as one of the most contagious viruses on Earth — five to 10 times more infectious than Ebola — and is among the first diseases to erupt in the wake of a disaster. In humanitarian crises in poor countries, it can kill up to 20% of those infected; usually those weakened by malnutrition and vitamin A deficiency.
Dr. Lessler and his collaborators estimated in a new study that a regional post-Ebola measles epidemic would strike roughly twice as many people as a pre-Ebola epidemic; an estimated 227,000 of infections compared with 127,000, and cause 2000 to 16,000 additional deaths. At the high end, the death toll could exceed the nearly 10,000 people killed by Ebola to date. However, nearly all of those deaths could be avoided by effective mass vaccination campaigns. That is why Liberia, with help from Centers for Disease Control and other international partners, is trying to launch a measles campaign as early as May that will target all children between 9 months and 5 years of age. Sierra Leone and Guinea are still affected by the Ebola disease so planning for measles vaccination is not considered a priority for the time being. (Leslie Roberts, Science)
Federal Biomedical Research
National Cancer Institute Director steps down
Harold E. Varmus, the Nobel Prize winner cancer biologist who has led the the National Cancer Institute (NCI) at the National Institutes of Health for nearly five years, stepped down from his post on March 31st. Dr. Varmus was co-recipient of the 1989 Nobel Prize for Physiology or Medicine for research into the cellular origins of cancer while conducting research at the University of California, San Francisco, where he joined the faculty in 1971. He was director of the entire NIH under President Bill Clinton from 1993 to 1999. Dr. Collins, the current NIH director, praised Dr. Varmus as being gifted with “unparalleled expertise.”
In his farewell letter to NCI staff, Dr. Varmus stressed the advances in oncology that NCI researchers led during his time as the NCI director in spite of the congressionally imposed budget cuts and budget sequestration that his institute and the entire NIH have had to endure in recent years. He wrote that his years at NCI “have not been easy ones for managing this large enterprise” and that “we have endured losses in real as well as adjusted dollars, survived the threats and reality of government shutdowns and have not yet recovered all the funds that sequestration has taken away.” He noted a range of scientific breakthroughs that have stemmed in part from NCI investments in recent years, from more widespread use of the HPV vaccine to greater acceptance of imaging tests in heavy smokers to pinpoint lung cancer, based on an NCI trial.
Dr. Varmus plans to return to New York and will head a laboratory in the Meyer Cancer Center at Weill-Cornell Medical College and also work with the New York Genome Center. Dr. Douglas Lowy, currently deputy director of the NCI and a researcher whose work led to development of the HPV vaccine to prevent cervical cancer, will become acting director April 1. (Thomas M Burton, Wall Street Journal)
Emergency Medicine Response
Having a companion is associated with faster treatment of stroke victims
The human element is much more significant in emergency medicine than initially believed by researchers. Dr. Gal Ifergane, a neurologist at Soroka University Medical Centre in southern Israel recently published in Medicine a striking story about the positive impact that relatives and friends have in the care and treatment of stroke victims when they accompany them to the ER. The most common stroke involves a clot blocking blood vessels in the brain, which causes almost immediate brain cell death because of the absence of oxygen transport. Thrombolytic therapy is very effective and uses drugs to dissolve the clot and restore the flow of blood. If started within a couple of hours of a stroke occurring, it can limit brain damage and reduce long-term disability. Time is a matter of life and death for these patients. Another key step is using a computed tomography (CT) scanner to ensure that there has been no bleeding in the brain, in which case thrombolytic drugs would cause excessive bleeding and would probably be lethal for the patient. In order to reduce the time to CT scan and correct treatment, paramedics have been trained to recognize strokes and warn hospitals in advance so that the medical team prepares accordingly.
Evidence for the significance of the human element in this case of emergency medicine came from 15 months of observation at Soroka Medical Center, where the ER staff recorded the number of companions escorting each stroke sufferer (over 700 in all) and monitored their progress. The results of this study showed that stroke victims arriving with someone were more than twice as likely to be correctly diagnosed by the triage nurse, and had their CT scans performed earlier. Patients eligible for thrombolytic medication also received treatment much faster if accompanied; although the patient sample was too small for the researchers to be sure it was because they had relatives or friends bringing them into the ER. The differences between the two groups cannot go unnoticed; patients with one companion had CT scans an average of 15 minutes sooner than those unaccompanied. A second companion reduced this time wait 20 minutes more; however, three or more companions did not confer any additional benefit. Dr. Ifergane believes that this is probably a combination of focusing the attention of clinical staff on their loved ones, and providing basic care when they initially arrive at the hospital. (The Economist)
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