Ebola Outbreak Update: Updated WHO Information through November 4th

The WHO has released updated information regarding the current outbreak of Ebola.

As of November 4th there have been 13,268 cases with 4,960 deaths.

Although there have been declines in new cases in some districts in the three countries hardest hit by the outbreak (Guinea, Sierra Leone and Liberia) other districts have seen sharp increases.

In the United States there have been no new Ebola cases and of the 177 people who may have come in contact with an infected individual only 16 are actively being monitored (161 have completed 21 days of monitoring without developing Ebola).

Congratulations to our GH2DP Student and Resident Researchers!

GH2DP Student Scholar Nehal Naik
in New Orleans

Congratulations to our GH2DP student and resident researchers who presented their research projects this week at the American Society of
Tropical Medicine & Hygiene's annual meeting in New Orleans. 

GH2DP Pathway Resident
Dr. El-Yafawi in New Orleans

Nehal Naik, now a second year medical student at VCU, presented his data on risk factors and knowledge about soil transmitted helminths in Yoro, Honduras. He also presented data on a novel water catchment device that was developed at VCU by students in the local chapter of Engineers Without Borders. 

GH2DP Student Scholar Rachel Pryor

Dr. Rama El-Yafawi, a senior global health pathway resident in VCU's Internal Medicine residency program, presented her data on barriers to use of water filters in Yoro, Honduras. 

Rachel Pryor, a GH2DP Student Scholar and MPH candidate at VCU presented her data on knowledge about and access to cervical cancer screening in Yoro, Honduras. 

Congratulations again to all of these terrific student and resident researchers!

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.

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.

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.

Ebola Outbreak Update: July 31-August 1

cdc.gov

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.

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.

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

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! 

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. 

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. 

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!

VCU GH2DP Honduras Group's Work Featured by VCU's Division of Community Engagement

Earlier this month our group traveled to the Yoro area of northern Honduras to meet with our community partners and ministry of health officials and to lay the groundwork for our June 2014 trip. The VCU Division of Community Engagement is now featuring our work on their site (this can be found here).

Also, the VCU undergraduate chapter of Engineers Without Borders was awarded a Quest Innovation Fund grant to support their development of novel rain catchment technology for use in Yoro. Congratulations to all of the students involved in this project!!!

VCU GH2DP Honduras Trip: Final Post

17 villages we serve in Yoro; the villages appearing in color
are those that may benefit from the new water chlorination
system (see text) 

This will be my final post prior to coming home tomorrow; this has been a whirlwind trip filled with productive meetings and some great new potential projects.

One of the projects we are most excited about is a new water chlorination project; piggybacking on older technology that is currently in place, new chlorination systems may, once installed, provide clean drinking water to 6 of the 17 villages we are currently supplying with water filters. We hope the chlorinated water will provide more consistent access to clean water in a more sustainable, community-driven way.

The map above unfortunately is not high resolution but provides a sense of the potential impact of the chlorination systems. The villages that appear in color are those that would be supplied clean drinking water via the new systems; the villages in gray are those in which clean drinking water will continue to be supplied by our current water filter project.

VCU GH2DP Honduras Trip: A Day in the Mountains

Hiking to Chorro Viento

Yesterday we got up early and left Olanchito to drive out to the rural, mountainous area where the people we serve live. This is a large area that consists of 17 villages and roughly 2,000 people. Because of logistical issues we have only visited 2 of these villages in the past (La Hicaca and Lomitas) and have coordinated with our community partners to have people from the outlying villages come see us in these places. Practically speaking, this means that some people have to walk 6 hours (each way) over mountains in the hot sun (it's typically in June and we are near the equator = hot, hot, hot) just to see us in clinic.

We were excited yesterday to have the opportunity to visits a few additional villages we have never

En route to Chorro Viento

been to: La Culatta and Chorro Viento. Our primary goal was to assess older water catchment infrastructure and to see if a new chlorination project is feasible and acceptable to people living in areas that would be served by the new technology.

We could drive to La Culatta but had to hike out to Chorro Viento; this was a 30 minute "walk," at least for people living in the area. For us it was more like 60 minutes and was as strenuous as any serious hike I have ever been on in the United States. Keep in mind this was the easiest village to reach and it's January-far cooler than June. I have always respected the mental and physical toughness of people living in the area but this has given me profound new respect. It is not uncommon to see a woman in her 70s walk 3-6 hours to come see us wearing what amounts to plastic shower sandals; I am confidant I could not keep pace with these women.

When we reached Chorro Viento we also got to see a project that was created in partnership with a group from the European Union: a working turbine that supplied power to this village. This is the only village in the region with power and was made possible by their proximity to a local river/ waterfall. The project was incredible and people in the village had enormous pride in the

Cistern in La Culatta; there are 4 of these
in the region supplying water to 5 of the
17 villages we serve; the water is not
safe to drink but a new chlorination
project may be able to provide clean water 

technology. What was truly amazing is the power poles-every bit as large as those found in the US-were carried up the mountain by people from the village. No heavy equipment could reach the village so the poles were planted by hand. The work must have been unbelievably strenuous.

People do so much with so little in the area, and a little really
does go a long way. I left yesterday with a renewed sense of admiration for the people living in the area and with a strong desire to do more to help people in the region. We are hopeful we can continue the many productive partnerships we have established in the region to help improve the health of its people. It is a great privilege to be able to come here, to be welcomed into the communities, and to be given the opportunity to help.

The region has traditionally had a problem with poor indoor
air quality related to poor stove ventilation in homes. Many homes have
now had improved ventilation systems installed and are
effectively ventilating smoke from homes

We also brought enough anti-worm medication
to provide another dose to everyone living
in the region (this is part of a long-term longitudinal
regional project to decrease the intestinal
worm burden) 

VCU GH2DP Honduras Trip: A Day of Meetings in Olanchito

Meeting with the local Minister of health and his staff

Our first full day in Olanchito was a whirlwind but very productive.

We met with the local Minister of health and his staff and discussed our work to date and future collaboration.

Meeting with our local community partners

We then met with our local community partners and thereafter with staff from the Pico Bonita Foundation. We discussed collaboration on new water chlorination systems that can provide clean drinking water to 5 of the 17 villages we serve; we are very excited about this potential project.

Meeting with the Pico Bonita Foundation

Today we are traveling to the mountains and will be hiking out to several villages (Chorro Viento and La Culata) to meet with people and investigate old water procurement infrastructure. Will then meet with our community partners in La Hicaca.

More to come!

VCU's Global Health & Health Disparities Program Sets Off for Honduras (Again!)

Traveling to La Hicaca 

Our group leaves this Sunday to meet with our community partners and the local Ministry of Health in Yoro, Honduras. We have traditionally used our January trip to meet with our key partners, review information from the prior brigade and to help lay the groundwork for the subsequent large-scale, clinical brigade in June.

Since 2008 we have been serving a series of 17 villages with approximately 2,000 people in rural, mountainous northern Honduras. People in the region have little to no access to healthcare and suffer from fundamental environmental health pressures (such as lack of access to clean water and latrines). 

We have a large-scale water filter program in the region that has been active since 2008. To date we have distributed over 350 water filters, each of which can provide clean drinking water to an entire family for 2 years (or more). We estimate approximately 75% of the people in the region have access to clean drinking water as a direct result

Preparing water filters for distribution 

of this program. Anecdotally, less children are developing (and occasionally dying from) diarrheal illness. More objectively, the incidence of severe diarrheal illness reported to the Ministry of Health has halved since the inception of the program. 

One of our projects this past June, a Chagas disease knowledge and attitudes survey, was performed at the request of the local health ministry. Chagas disease is a parasitic disease that is common in Latin America and is associated with severe cardiac and gastrointestinal morbidity. We will be sharing the results of the project with our partners this upcoming week; we are excited to discuss study implications and next steps.

Working on the indoor air quality project

Two years ago the health ministry and local leaders asked us to investigate the problem of indoor air pollution. A now-third year VCU medical student, Audrey Le, formally assessed the issue and found certain home characteristics were associated with respiratory symptoms. Subsequently we discovered many stoves were in a state of disrepair and not effectively ventilating smoke. This upcoming week we will be meeting with a local non-profit organization who may be able to help repair these defective stoves; we are excited about this potential collaboration.

Additionally, we are excited to discuss several upcoming surveys we hope to administer in June: looking at knowledge, attitudes and risk factors for intestinal helminth (worm) infection and a survey on women's health issues. We also are partnering with a VCU undergraduate group, Engineers Without Borders, to explore a novel rain catchment technology (to help provide clean drinking water) and will be conducting a survey focused on barriers for optimal use of water filters. 

Clinic in Lomitas

During next week's trip we will also be supplying anti-helminthics to help bolster regional efforts for intestinal worm control. We will also be doing the groundwork for our upcoming clinical mission; figuring out key logistics such as clinic space, how to recruit patients, et cetera. 

I will post about our trip either during the trip or shortly thereafter; stay tuned. Dr. Gonzalo Bearman will also be posting about the experience, be sure to check out his blog. You can also follow our progress on twitter here.