Friday, October 31, 2014

WHO Ebola Update: 10/29/14

The latest WHO Ebola update document has been posted and can be found here. As of 10/27 there have been 13,703 cases with 4,922 deaths. Mali had its first case on 10/23, a 2 year old girl who traveled there with her grandmother from Guinea. In the US there have been 4 cases and 1 death. The outbreak remains uncontrolled in Guinea, Sierra Leone and Liberia.

Friday, October 24, 2014

WHO: Updated Ebola Outbreak Information

The latest WHO Ebola situation report can be found here. Key points:

1) As of 10/19 there have been 9,936 cases and 4,877 deaths
2) The outbreak in Senegal was declared over on 10/17
3) The outbreak in Nigeria was declared over on 10/19

Up until 10/19 there had been only 3 cases in the US (now 4 given the physician who has developed Ebola after returning from Guinea-not on the latest WHO document). For the 3 reported on in the WHO document there were 172 possible contacts of these patients 60 of who were past the 21 day incubation period and therefore deemed non-infected.

Saturday, August 16, 2014

West Africa Ebola Outbreak: August 15th Update

The WHO has released updated information on the total number of people affected by the Ebola outbreak in West Africa: as of August 15th there have been 2,127 suspected and confirmed cases with 1,145 deaths.

Cases are being reported in Guinea, Sierra Leone, Liberia and Nigeria.

The CDC has a lot of very nice, targeted health information about Ebola: see here.

Monday, August 4, 2014

Ebola Outbreak Update: July 31-August 1
The World Health Organization has posted updated information on the Ebola outbreak in West Africa.

Between July 31 and August 1 there were 163 new (presumptive) cases with 61 deaths; cases are being reported from Guinea, Liberia, Sierra Leone and Nigeria.

The total number of presumptive cases is now 1,603 with 887 deaths; at this point the outbreak is nowhere near contained and current infection control efforts appear inadequate. Unfortunately there are no Ebola-specific therapies available; treatment is supportive in nature and the disease carries a very high mortality rate (71-86% based on a recent report in the New England Journal of Medicine).

Total Ebola Cases/ Deaths Per Country to Date
As noted recently by CDC director Dr. Thomas Frieden "Ebola poses little risk to the U.S. general population." From an infection control standpoint preventing disease transmission is relatively easy, at least on paper and in resource-rich environments. The disease can be prevented by preventing contact with potentially infected blood and body fluids in people with suspected infection, coupled with aggressive contact tracing, monitoring and isolation of people who may have been exposed. This said, there are many barriers to effectively controlling the current epidemic, not the least of which is access to critical infection control resources and personnel.

One of the factors that promoted the expansion of the current outbreak was the long time it took for the outbreak to be recognized. Cases of people with a disease characterized by vomiting and diarrhea with a high mortality rate were first identified in clusters in Guinea in December 2013; the outbreak was not reported to international authorities until March 2014. As a global community we need to promote access to resources and technology that support the rapid detection and diagnosis of key infectious diseases; this is in all of our best interests. This current outbreak is yet another reminder that new (and old) diseases will continue to emerge and that something that emerges in a 'remote' part of the world can rapidly become a global issue.

Sunday, July 13, 2014

Ebola Outbreak in West Africa

Areas involved with current outbreak 
The WHO recently reported on the status of the ongoing Ebola outbreak in West Africa; as of July 8th there have been 888 cases with 539 deaths. Although the outbreak seems to be slowing in Guinea it is still very active in Sierra Leone and Liberia, where 44 new cases and 21 deaths were reported between July 6 and 8.

Ebola Virus Disease (EBV), also known as Ebola Hemorrhagic Fever, refers to a viral infection with several different species of a filovirus. First identified in two outbreaks in the Sudan and the Democratic Republic of the Congo in 1976, Ebola causes a severe acute illness characterized by bleeding and a mortality rate up to 90%.

Most of the Ebola outbreaks to date have occurred in small villages in West and Central Africa near tropical rain forests. The natural host of the virus is believed to be fruit bats. Animals such as chimpanzees, gorillas and monkeys can become infected with the virus after coming in contact with bats; these animals are "accidental" hosts, just like humans. Humans become infected via handling blood and body fluids from infected bats or other animals. Once someone is infected with the virus they then go on to serve as a source of transmission to other humans via their own infected blood, tissues and secretions.

The incubation period for Ebola after being infected is anywhere from 2-21 days; humans are not
infectious until they develop symptomatic illness. Ebola initially is a non-specific illness characterized by sudden fever, intense weakness, muscle pains, sore throat and headache. These symptoms are followed by vomiting, diarrhea, rash, organ dysfunction and sometimes bleeding. Once symptomatic, a person's blood and body fluids are highly infectious and serve as a source for potential human to human transmission of disease.

As noted above, Ebola is associated with mortality rates of up to 90%. There is no specific treatment or vaccine for the disease.

Distribution of different Ebola outbreaks
The ongoing, sustained outbreak of Ebola in West Africa is concerning for several key reasons. This large-scale outbreak in multiple locations is testament to just how 'small' the world has become. A disease that emerges in a rural village can spread rapidly to major cities and, theoretically, to the rest of the world. This is a great reminder that we all should be concerned with and help in the response to outbreaks such as these. Also, this outbreak highlights some of the barriers to enacting the infection control measures that would allow for its control. Specifically, it is believed some cultural burial practices have perpetuated the outbreak via exposing uninfected people to the infected blood, secretions and organs of Ebola victims.

The WHO has terrific information on Ebola available here. Some great information is also available from the CDC.

Friday, June 13, 2014

VCU GH2DP Outreach Trip to Yoro: Pictures Published

Outreach group in La Hicaca 
An overview of our recent outreach trip to Yoro, Honduras has been published on the GH2DP website and can be found here. A slideshow of pictures from the trip can be found here.
Distributing water filters, Lomitas
Dental clinic, La Hicaca

Engineers Without Borders students with water test plates
Medicine clinic, La Hicaca
Medicine clinic, La Hicaca
Medicine clinic, Lomitas

Sunday, June 8, 2014

VCU GH2DP Yoro trip: kissing bugs and a new way to obtain clean water

Here is a brief post from Olanchito, Honduras. I want to share a few more pictures and highlight a few more of the experiences we had on our outreach trip.

Chagas disease is a major issue for the communities we serve in Honduras; this is an infection carried in the gastrointestinal tracts of "kissing bugs." These bugs feed on humans and defecate; the feces is irritating and the Chagas parasite is then inoculated into that person's blood when they scratch. Chronic infection causes significant morbidity and mortality, leading to heart failure and arrhythmias, amongst other complications. Our colleagues from Brock University and the National Autonomous University of Honduras identified these "kissing bugs" for our group-see the picture below.

The picture below is with our colleagues from Brock and the National Autonomous University of Honduras.

The picture below is of a novel rain catchment device that was put into place by VCU Engineers Without Borders students Lucas Potter and Kristina Kelly. They also performed formal interviews to determine the barriers to adopting this technology on the communities we serve. 

More to come, stay tuned! 

Saturday, June 7, 2014

VCU GH2DP Yoro outreach trip: back from the mountains!

This is an early recap of our GH2DP outreach trip to the mountains of rural Yoro, Honduras-blogging from the car on the way back to Olanchito.  We just spent the past 5 days providing medical care to people in a region with little to no access to care. All told, we saw approximately 750 people over 6 days of clinic. We reached people from twenty different villages. All adults were screened for diabetes, hypertension, de-wormed and had acute medical issues addressed, as well. We managed and triaged preseptal cellulitis, new-onset seizure disorder, hemorrhage requiring acute transport to a regional hospital and leishmaniasis.

We distributed 83 water filters (each of which can provide clean drinking water to an entire family for 2 years) and facilitated approximately 90 pap smears and dental extractions for 97 patients. We administered over 460 surveys on topics ranging from women's health issues, barriers to water filter use, new water catchment technology and soil transmitted helminths. Dr. Ana Sanchez and colleagues from Brock University examined stool samples on several scores of people, helping to identify recalcitrant worm infections and connecting these patients to appropriate care.

We screened patients for vision issues and distributed 67 pairs of eyeglasses. A new water catchment system was trialed and microbiological testing was performed on over 30 water samples. Students and residents received didactic and clinical lectures on dengue, soil transmitted helminths, diarrhea, malaria and Chagas' disease, among other topics. We had an absolutely terrific group of highly motivated student and resident physicians. Four students in our GH2DP Student Scholars program completed research projects as did our GH2DP pathway resident. All in all a fantastic trip! Will blog more in the near future with pictures. 

Wednesday, May 28, 2014

June 2014 GH2DP Outreach Trip to Yoro: Preview

Our group leaves for the mountains of the Yoro province of Honduras this coming Sunday, where we will spend over a week seeing patients and participating in a number of public health projects.

Testing for bacterial water contamination (presence of
color = growth of bacteria) 
This marks our 9th large-scale medical mission to Honduras since 2005. Initially our efforts were primarily focused on providing acute medical care. Since that time our work has expanded to include numerous public health projects including a large-scale, filter-based clean water initiative that has led to supplying approximately 1,500 people with clean water. Additional efforts have included regular mass de-worming, an indoor air pollution assessment and subsequent education initiative, several mass anemia screenings, improved access to cervical cancer screening and a large Chagas disease knowledge and attitudes assessment. Our group has been blessed to have wonderful community partnerships which help to direct and facilitate our efforts. In the nearly one decade since we have been active in Honduras we have come along way... but there is much, much more to do. 

Our program (the Global Health & Health Disparities Program, GH2DP) has a tripartite mission: improve the health of people with poor access to healthcare, expose US-based learners to medicine in resource-poor settings and to systematically study our efforts to learn what works and what doesn't. This work has involved the efforts of myriad individuals, non-profit organizations and academic departments here at VCU. 
Medicine clinic, La Hicaca 

Since 2005 we have seen over 10,000 patients. Beyond providing acute medical care we now regularly screen and treat patients for chronic diseases such as diabetes and hypertension. We also screen patients for vision issues and provide eye glasses, help facilitate dental extractions and help support cervical cancer screening, as well. Every person in the 17 villages we serve receives anti-worm medication at least twice yearly; since 2008 we have distributed nearly 20,000 doses of anti-worm medication. 

Assembling and cleaning water filters 
Our clean water program provides water filters that are created in-country and provide clean drinking water to entire families for up to 2 years. Since the inception of the program we have distributed 401 filters and now provide clean water to approximately 1,500 people (roughly 75% of the region we serve). This year we are partnering with a local non-profit organization to provide entire villages with clean drinking water via a chlorination project involving cisterns. It is estimated that 6 of the 17 villages we serve will have access to clean drinking water via this project-without the need for water filters. 

In terms of educational efforts, to date we have provided global health experiences to approximately 80 students and residents. Of these learners, 32 have been afforded advanced mentorship on public health research projects that have led to 10 publications and 15 presentations at national and international conferences. More importantly, their work has advanced our medical and public health missions. Additionally, we have an active GH2DP residency pathway which involves over 150 hours of advanced training in global health as well as a Student Scholars program

Our June trip may be our most ambitious ever. We have assembled a fantastic team of students who have been working hard the past 9 months raising money to help procure medicines and supplies. We also have a terrific group of residents and other staff.

We have 4 survey projects planned: one focused on worm infections, one on women's health issues, one on barriers to water filter use and one on access to clean water. Additionally, we are partnering with researchers from Brock University who will be doing fecal testing to evaluate the regional worm burden and the effectiveness of our mass-deworming program. As well, a group of engineering students from VCU will be traveling with us to trial novel water catchment technology. We anticipate seeing approximately 1,000 patients, or roughly half of the population of the region we serve. 

Stay tuned for updates on the trip. 

Friday, April 11, 2014

VCU Honduras Outreach Projects Presented at Global Health Showcase, International Congress on Infectious Diseases

Audrey Bowes (VCU second year medical student)
presenting on an outreach project on indoor air pollution
in Yoro 
The second VCU Global Health Showcase was held on April 1, 2014, and involved a series of oral presentations as well as a poster session. Multiple students and fellows who have been involved with global health work at our Global Health and Health Disparities Program (GH2DP) site in Yoro, Honduras, presented on their findings.

Audrey Bowes, a VCU second year medical student, presented on an education project focused on indoor air pollution in Yoro.

VCU Engineers Without Borders students
presenting on their work on novel water catchment
technology (left to right: Matt Beckwith,
Katelyn Boone, Viktoria Pretzman,
Kristina Kelly, Lucas Potter)
VCU undergraduate engineering students from the group Engineers Without Borders (EWB) presented on their work creating novel water catchment technology. Members from the EWB group will be traveling to our Yoro, Honduras site in June to trial this technology.

Additionally, Summer Donovan, a pediatric Infectious Diseases fellow at VCU, presented on her 2013 project looking at Chagas disease knowledge and attitudes in Yoro.

With Dr. Gonzalo Bearman at Gaby Halder's
poster on clean water storage, International
Congress on Infectious Diseases, Cape Town,
South Africa 
Gaby Halder (a 4th year medical student who will be graduating in May) also had her research on clean water storage presented at the International Congress on Infectious Diseases meeting that just concluded in Cape Town, South Africa.

Congrats to all of these outstanding student/ fellow researchers!