Yellow Fever Vaccination Boosters: Unnecessary per WHO

Aedes aegypti mosquito (the mosquito that transmits the
yellow fever virus); cdc.gov

Here is a press release from the World Health Organization regarding yellow fever vaccination; this is a 'game changer' for immunization programs in endemic countries as well as for people traveling to endemic areas.

"Yellow fever" refers to the disease caused by the yellow fever virus that is transmitted by mosquitoes in areas of Africa and South America. This a hemorrhagic fever virus associated with substantial mortality and high morbidity. Worldwide there are approximately 200,000 cases yearly with 30,000 deaths. Although a safe and effective vaccine is available for this disease, there is no treatment (other than supportive care) for people who contract it. 

The press release refers to an analysis that was done looking at whether "booster" doses of yellow fever vaccine are needed following initial vaccination. The current practice is to administer a booster dose every 10 years. Yellow fever is (nearly) unique in that it is one of the only vaccine-preventable diseases where there is an international requirement to have documentation of having received the vaccine (or having a medical contraindication) to allow travel to many countries in Africa and South America. The vaccine is generally well tolerated, although it is a live virus vaccine and is contraindicated for people with immune-suppressing conditions. 

The press release noted that over 600 million doses of yellow fever vaccine have been administered since the 1930s when yellow fever vaccination began. There have only been 12 cases of yellow fever following vaccination and these did not occur greater than 10 years following vaccination; all told, the analysis was inconsistent with waning immunity and need for booster immunization. 

This is welcome news, although time will tell how this will effect vaccination programs as well as international travel requirements for yellow fever vaccination. 

More on the VCU Global Health Symposium

VCU Global Health Symposium speakers

More on the recent First Annual VCU Global Health Symposium can be found on the university's global education website here.

The meeting took place on Saturday, April 27th, and brought together students, residents and faculty from across the university. One of the key goals of the meeting was to provide a platform for sharing ideas, networking and developing the framework for future collaboration. The meeting featured short talks focused on research at both the community and international levels, and a poster session.

Our group (the VCU Global Health and Health Disparities Program, or GH2DP) provides both medical care and public health interventions to approximately 2,000 people living across 17 villages in rural Honduras. As a result of the VCU Global Health Symposium we have new contacts and new ideas including improving mental health services in the region as well as clean water infrastructure. 

Going Global: Workshop on Providing Global Health Experiences to Residents Presented at Spring APDIM Meeting

With Drs. Cosco and Sam at the Association of Program
Directors in Internal Medicine conference in Orlando, Florida

I had the great opportunity to co-lead a workshop on providing global health experiences to residents at this week's Association of Program Directors in Internal Medicine's Spring conference in Orlando, Florida.

With colleagues from Emory and Kaiser Permanente, we discussed barriers, resources and different models of providing global health experiences to internal medicine residents. The slides from our talk can be found here.

There is an enormous amount of interest in global health at both the medical student and resident levels; providing these experiences can be difficult, however. Some of the key issues include finding international partners, securing adequate funding, providing adequate supervision as well as many other logistical challenges.

To date, we have been able to provide global health experiences to approximately 60 medical and pharmacy students as well as over 20 internal medicine residents via the VCU Global Health & Health Disparities Program (GH2DP). Students and residents work with patients and communities in rural Honduras, where they participate in direct medical care and public health work.

We had a good turnout at the workshop and hope that we have created a framework via which medicine programs can continue to share ideas and best practices in providing global health experiences to residents moving forward.

Inaugural VCU Global Health Symposium

VCU Global Health and Health Disparities research team reunion
(from left to right: Dr. Bearman, Kate, Jackie, Gaby, Audrey)

Today the inaugural VCU Global Health Symposium was held in Richmond, Virginia, bringing together faculty and students from across the university who are involved in global health efforts.

One of the key goals of the meeting was to provide a platform for sharing ideas, networking and developing the framework for future collaboration. The meeting featured short talks focused on research at both the community and international levels, and a poster session.

Dr. Moskowitz presenting on a national rheumatic fever
project in the St. Vincent and the Grenadines

Researchers presented on both local community health projects (including our clean water project in northern Honduras, as well as a skin cancer prevention project in Peru and a dental project in Jamaica) and a later session focused on country-wide global health efforts. These included a project focused on rheumatic fever surveillance in St. Vincent and the Grenadines, trauma infrastructure development in Latin America, student education projects in India and medical simulation education in Poland. The meeting was capped off with an inspiring talk on global health research by the dean of the VCU School of Medicine Dr. Jerome Strauss.

Twenty students and residents presented 22 posters related to global health research and health outreach. Our northern Honduras group was well represented with 4 students presenting 5 posters (way to go Jackie/ Gaby/ Audrey/ Kate!).

I left the meeting inspired, re-charged and with some fresh ideas; better yet, our group now has some potential new collaborators. I am already looking forward to the 2014 symposium!

"Rams Reaching Out" Exhibit: Highlighting VCU Health Science Students' Outreach Work

For anyone in and around Richmond, there is a cool exhibit on display at the Tompkins-McCaw library. The exhibit includes photographs from VCU students who have participated in health outreach efforts (and highlights activities in rural Virginia, El Salvador, Peru, Honduras, Costa Rica, Togo and other places). Definitely a lot of good work going on and worth taking a look at if you are in the area.

Introducing The Medical Literary Messenger

I am excited to announce that the Medical Literary Messenger (MLM), the brainchild of my friend and colleague Dr. Gonzalo Bearman, has been launched.

This is an online literary magazine including works of fiction, nonfiction, poetry and photography focused on "the art of medicine and creative expression."

Anyone can submit works to the journal, and material focused on topics in and around healthcare, from any and all angles, will be considered.

I have the great honor of being the Associate Editor for Photography for MLM and am really excited about this project.

You can find out more at the journal's website.

SIGoVA: Pushing Antimicrobial Stewardship Forward in Virginia

With Drs. Lee, Collins and Bucheit
(founding members of SIGoVA). 

I had the great opportunity to present today on Antimicrobial Stewardship (AS) at the Virginia Society of Health-System Pharmacists' Spring Conference. My talk was given in the context of several hours of talks and a panel discussion designed to raise awareness about AS and to promote a regional AS interest group that was created over the past year: the Stewardship Interest Group of Virginia (SIGoVA).

My talk focused on why AS is so important (the problem of antibiotic resistance and our dwindling arsenal of antibiotics) and current best strategies in AS practice as well as key challenges facing AS practitioners today.

The SIGoVA group was created to provide a forum for

Antimicrobial stewardship panel participants 

people in an around Virginia to discuss issues surrounding antibiotic resistance, stewardship and to share information and best practices.

You can find out more about the problem of antibiotic resistance here; you can find out more about antibiotic stewardship here. To find out more about SIGoVA please visit our website.

As the 'pipeline' of new antibiotics for key multi-drug resistant organisms has essentially run dry, it is now more important than ever that we preserve the antibiotics we have and prevent infections wherever possible. Groups such as SIGoVA can help facilitate AS by sharing knowledge, experience and ideas.

Dengue: Over Three Times More Common Than Previously Thought

Aedes aegypti mosquito
(cdc.gov) 

Here is a new article on the worldwide incidence of dengue viral infections that was just published by Bhatt and colleagues in Nature.

Dengue is a viral infection transmitted by Aedes aegypti (and Aedes albopictus) mosquitoes; it is the most common mosquito-borne viral infection. It causes an acute febrile illness characterized by severe pain (which gives the disease its colloquial name: "breakbone" fever). Although not associated with high mortality, the disease is nonetheless associated with significant morbidity.

Using worldwide data on dengue incidence as well as statistical modeling, these authors estimate that there are upwards of 390 million dengue infections per year, with approximately one third of people actually having symptomatic disease. Three-hunded and ninety million is a pretty staggering figure (just around 5% of the world's population), and is over three times the estimated annual incidence per the WHO.

Here in the United States, this is definitely an issue "right in our backyards." In recent years we have seen dengue expand into previously unaffected areas, including the southern United States.

The study by Bhatt and colleagues will hopefully further raise awareness about dengue and the need for a coordinated global strategy to combat it.

Update on Human H7N9 Avian Influenza Cases in China

VCU Global Health & Health Disparities Program (GH2DP)
group entering Honduras during the H1N1 pandemic, 2009

Here is the latest update from the WHO on human H7N9 avian influenza cases in China; as of April 5 16 patients have laboratory-confirmed infection (up from just 3 a few days ago) and 6 have died. Contacts of the people who are infected are being closely watched for signs and symptoms of respiratory infection; to date no clear evidence of person to person transmission has been found.

Although it not clear yet where people acquired H7N9, the virus has been detected in pigeons in a major Chinese agricultural market, leading to the mass execution of 20,000 birds.

Here is an April 4th health advisory on H7N9 from the CDC and an April 5 'telebriefing' with the CDC's director Dr. Tom Frieden. Here is detailed, specific travel advice from the CDC for people going to China (emphasizing such things as avoiding live bird and poultry markets, practicing good hand hygiene, et cetera).

Much is unknown about the epidemiology and transmissibility of the H7N9 virus; to date it does not look efficient in terms of person to person transmission, which is the public health community's greatest concern. One thing is certain: these new human cases of "bird flu" illustrate how quickly novel infectious disease threats can emerge, and we must be vigilant and act quickly as a global community to identify, contain and development treatments for these diseases when they appear.

New Article on Zombies Published in Emerging Infectious Diseases

cdc.gov

Here is an interesting article that was just published in Emerging Infectious Diseases on the use of the public's general fascination with zombies for public health education.

The article refers to back to an earlier CDC blog post that used a "zombie apocalypse" as a vehicle for educating about disaster preparedness. I definitely remember when this clever 2011 CDC blog post was published, and the general content of the message. I have to admit that I can not recall any other general disaster preparedness messages delivered by the CDC or any other group... perhaps there really is something to tying health messages to fictional, highly memorable content?

The current Emerging Infectious Diseases article provides both historical background information on zombies as well as information on their popularity across a variety of media/ entertainment platforms (books, films, video games, et cetera).

The article discuss how public health messages that pull from fictional depictions of zombies could be used to educate about such real-world issues as infection control, risk for bioterrorism, disaster preparedness, provide a framework for ethical discussions, et cetera.

The authors provide a real-world example of the mass killing of 50,000 or so dogs in Bali in 2008 in an effort to control a rabies outbreak; this led to a discussion about the most optimal, ethical, control of rabies in a given area (e.g., mass killing versus vaccination). The authors of the Emerging Infectious Diseases article posit that ethical dilemmas depicted in fictional dramas (such as those involving zombies) can help provide a relatable framework for real-life infection control and infectious diseases issues.

Anyway, I am going to stop blogging now so I can go work on my emergency kit/ plan; you never know.