tag:blogger.com,1999:blog-30593214771386389662024-03-06T12:01:08.698-08:00Bugs, Drugs & Global Health Commentary on Infectious Disease & Global Health IssuesMike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.comBlogger141125tag:blogger.com,1999:blog-3059321477138638966.post-46551794967061776082016-02-28T03:17:00.001-08:002016-02-28T03:17:22.621-08:00Sexual Transmission of Zika Virus More Common Than Previously Reported The CDC has released <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6508e2er.htm?s_cid=mm6508e2er.htm_w" target="_blank">a report </a>of 14 possible cases of sexual transmission of Zika virus infection to women; these were reported to the CDC between February 6 to February 22. In all of these cases the only risk factor for disease was having sex with a symptomatic man who had recently traveled to a region with known Zika virus transmission. The authors note that the "sexual transmission of Zika virus is more common than previously reported." <div>
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The full report can be found <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6508e2er.htm?s_cid=mm6508e2er.htm_w" target="_blank">here</a>. </div>
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To date only male to female sexual transmission has been described. It is still unclear just how long Zika virus can persist in semen. The CDC continues to recommend abstinence or condom use for men residing in or who have traveled to areas with Zika virus transmission; what is still unclear is for how long these measures are necessary to prevent Zika virus transmission.</div>
Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-1767201728737685192016-02-26T10:52:00.000-08:002016-02-26T10:52:26.285-08:00Physicians and Social Justice I was forwarded a link to a very compelling and thought-provoking TED talk:<br />
<br /><a href="http://www.ted.com/talks/mary_bassett_why_your_doctor_should_care_about_social_justice" target="_blank">"Why Your Doctor Should Care About Social Justice." </a><br />
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This is well worth taking a look at it, especially for healthcare providers.<br />
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<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-51140652191659469072016-02-18T02:21:00.000-08:002016-02-18T02:21:39.202-08:00Zika Virus in SemenA <a href="http://wwwnc.cdc.gov/eid/article/22/5/16-0107_article" target="_blank">new letter to the editor</a> published online in <a href="http://wwwnc.cdc.gov/eid/article/22/5/16-0107_article" target="_blank">Emerging Infectious Diseases</a> adds to the data about Zika virus persistence in semen.<br />
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A 68 year-old man developed symptomatic Zika virus infection after traveling to the Cook Islands. Zika virus was detected in his semen by polymerase-chain-reaction testing as far out as 62 days after onset of his illness. The authors were unable to culture Zika virus directly from his semen, however.<br />
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The full text of the article is available <a href="http://wwwnc.cdc.gov/eid/article/22/5/16-0107_article" target="_blank">here</a>.<br />
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There is still much that is unknown about potential sexual transmission of Zika virus, including how commonly Zika virus persistence in semen occurs, how long this persistence is for and how commonly sexual transmission occurs.<br />
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Current recommendations from the CDC for preventing sexual transmission of Zika virus infection can be found in the <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1.htm?s_cid=mm6505e1_e" target="_blank">February 12, 2016 Morbidity and Mortality Weekly Report (MMWR)</a>. <br />
Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-2975807703651447782016-02-11T12:01:00.001-08:002016-02-11T12:01:42.356-08:00Zika Virus and Microcephaly: More Evidence of a Causal LinkA <a href="http://www.nejm.org/doi/pdf/10.1056/NEJMoa1600651" target="_blank">case report in the New England Journal of Medicine</a> was published yesterday that provides further evidence of a link between microcephaly, brain damage and congenital Zika virus infection.<br />
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A 25 year old healthy pregnant woman developed symptoms consistent with Zika virus infection while in Brazil. Microcephaly was discovered on fetal ultrasound around 29 weeks of gestation and her pregnancy was terminated around 32 weeks given the concern for severe brain damage. A fetal autopsy was performed and revealed severe brain damage and zika virus was identified in the fetal brain tissue with reverse transcriptase polymerase-chain-reaction (RT-PCR) testing. These findings are more evidence for the connection between congenital Zika virus infection and severe brain injury and microcephaly.<br />
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The full text of the article can be found <a href="http://www.nejm.org/doi/pdf/10.1056/NEJMoa1600651" target="_blank">here</a>.<br />
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More basic science and epidemiologic research is needed to better understand the relationship between congenital Zika virus infection and abnormal fetal development and to best identify strategies to prevent disease.<br />
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<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-58120112833252417952016-02-11T03:52:00.000-08:002016-02-11T03:54:48.734-08:00Congenital Zika Virus Infection and Eye DiseaseA <a href="http://archopht.jamanetwork.com/article.aspx?articleid=2491896" target="_blank">study was just published in Jama Ophthalmology</a> looking at infants with microcephaly and presumptive congenital Zika virus infection in Brazil. Twenty-nine infants with microcephaly and presumptive congenital Zika infection were identified between December 1st and December 21, 2015.<br />
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The full text of the article can be found <a href="http://archopht.jamanetwork.com/article.aspx?articleid=2491896" target="_blank">here</a>.<br />
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Twenty-three of the 29 mothers (79%) reported a disease compatible with Zika infection during pregnancy; the majority (18/23, 78%) reported disease occurring in the first trimester. Ocular abnormalities were found in 10 of the 29 children (35%). These abnormalities included focal pigment mottling of the retina, chorioretinal atrophy, optic nerve abnormalities, colobomas and lens subluxation.<br />
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Congenital Zika virus infection has been linked to microcephaly, and now there is evidence that it is also associated with potential vision-threatening ocular abnormalities. More research is needed to identify the true relationship between congenital Zika virus infection and ocular abnormalities as well as to identify the best strategies to avoid congenital infection altogether. For now, ophthalmologic evaluation of infants born with microcephaly in regions with Zika transmission is warranted.Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-9123247003195176892016-02-07T02:30:00.000-08:002016-02-23T19:27:40.856-08:00Zika Update: CDC Advice for Preventing Sexual Transmission <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi92kcA85VIehjhrcwNc2tc0imrNEuJnyv3HN2fWTucpllo137IofjKsCgjxT1zH_nUrFEEtgAQiK_7_qMdczTOmWe7ew6WtIQs3BrPwsOFAUUfSGhkaI0ebZXh0OMo1iUbh0Py_mvHi3LH/s1600/Screen+Shot+2016-02-07+at+5.22.37+AM.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi92kcA85VIehjhrcwNc2tc0imrNEuJnyv3HN2fWTucpllo137IofjKsCgjxT1zH_nUrFEEtgAQiK_7_qMdczTOmWe7ew6WtIQs3BrPwsOFAUUfSGhkaI0ebZXh0OMo1iUbh0Py_mvHi3LH/s320/Screen+Shot+2016-02-07+at+5.22.37+AM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Areas with active Zika virus transmission in the Americas (CDC)</td></tr>
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Guidance for preventing the sexual transmission of Zika virus was published in the <i><a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_w.htm" target="_blank">Morbidity and Mortality Weekly Report</a></i> on February 5th.<br />
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This article alludes to the three known cases of sexual transmission of Zika virus infection. These all involved male to female transmission with Zika virus being found in semen. In all cases the men were symptomatic.<br />
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The CDC is <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_w.htm" target="_blank">currently recommending abstinence or condom use for men with pregnant partners who are in or who have returned from areas where Zika virus transmission is occurring</a>. In the above document the duration of time abstinence or condom use is recommended is not delineated. Some experts estimate up to 50% of pregnancies are unplanned, however. Given this, careful family planning consideration is warranted for all women with male partners residing in or traveling from areas with Zika transmission.<br />
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What is not known:<br />
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1) How long Zika virus can persist in semen after active infection. In one of the above cases it appeared to be present 2 to possibly 10 weeks following symptom outset; this is much longer than the virus is typically detected in the blood (less than or up to about a week).<br />
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2) How common is sexual transmission of Zika virus infection?<br />
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3) Will all men capable of sexually transmitting Zika virus be symptomatic?<br />
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4) Does female to male sexual transmission of Zika virus occur? What about male to male transmission? Or female<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6NcSjUJmrjsYUwkMQLa5yjH33cto67hX_Kqi2tNIswu3cb4xD9IIWvnfR0xBf8okALml80cBLpqt8gwjB6fF6kahLlvZp46_1ZytBH4ZEKIpzAxmNv-C1kJsWT6ghsEJZmLAZZ5f4hS_X/s1600/Screen+Shot+2016-02-07+at+5.23.38+AM.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6NcSjUJmrjsYUwkMQLa5yjH33cto67hX_Kqi2tNIswu3cb4xD9IIWvnfR0xBf8okALml80cBLpqt8gwjB6fF6kahLlvZp46_1ZytBH4ZEKIpzAxmNv-C1kJsWT6ghsEJZmLAZZ5f4hS_X/s320/Screen+Shot+2016-02-07+at+5.23.38+AM.png" width="251" /></a></div>
to female transmission?<br />
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5) How long should men who are in or who have returned from areas with Zika virus infection abstain from sex or use condoms?<br />
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At this point sexual transmission of Zika virus infection appears to be rare (with only 3 documented instances of this to date). More data is needed to answer the questions above and to best identify how to protect people living in and traveling to areas with Zika virus transmission.<br />
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<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-88383713529046444692016-02-04T05:07:00.001-08:002016-02-04T05:08:20.863-08:00More on the Zika Virus <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1qoyAi8TahtjBGoVQtolWZXqn1PELpTgcrshvMDKlLL7_cu8Yezm5x1YWEi-XiAV4HTrXn49seYm3szpMelQdvB9IDlXImLE5txGiU0ssTGU70yi4sKLneNwhaX3cqz9b72ieqoJ7lpBZ/s1600/Screen+Shot+2016-02-04+at+8.05.05+AM.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1qoyAi8TahtjBGoVQtolWZXqn1PELpTgcrshvMDKlLL7_cu8Yezm5x1YWEi-XiAV4HTrXn49seYm3szpMelQdvB9IDlXImLE5txGiU0ssTGU70yi4sKLneNwhaX3cqz9b72ieqoJ7lpBZ/s320/Screen+Shot+2016-02-04+at+8.05.05+AM.png" width="294" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Aedes aegypti</i> mosquito (CDC)</td></tr>
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Here is some more general information on the Zika virus. More information continues to emerge about this infection and the below represents a general understanding of these infections to date. </div>
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<a href="http://www.who.int/mediacentre/factsheets/zika/en/" target="_blank">Zika virus was first discovered in Uganda in 1947 and subsequently spread to Southeast Asia.</a> There were outbreaks in Micronesia in 2007 and French Polynesia in 2013-2014. In May 2015 it was discovered in Brazil and now has been reported from numerous countries in South America, Central America and the Caribbean. Like Chikungunya before it, widespread infection in these areas is anticipated/ being documented. It is believed up to 4 million people in the Americas may ultimately become infected. </div>
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Zika virus is primarily transmitted via the bites of day-biting <i>Aedes </i>mosquitoes, especially <i>Aedes aegypti. </i>These mosquitoes do exist in the United States but mostly reside in tropical and sub-tropical regions. <i>Aedes albopictus</i> mosquitoes are distributed more widely in the United States and are believed to be able to carry Zika virus as well but have not been implicated to the same extent as <i>Aedes aegypti</i> in the current outbreak. </div>
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<a href="http://www.cdc.gov/zika/symptoms/index.html" target="_blank">Only approximately 20% of people who become infected with Zika manifest symptoms</a>. These<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM2pEeD9LHn7fmi_3DJbWmF4BCczHJPZdY0N_hfAJE8byoXxmI8XUYd3zArr9RVzvyXMytdJnYAg2SXejDjNV0aCiaykVw0ys3EpLKcmZC97gGIejtsF7bA6cUm5OBjtRyzlpMLR3n449P/s1600/Screen+Shot+2016-02-04+at+8.05.41+AM.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgM2pEeD9LHn7fmi_3DJbWmF4BCczHJPZdY0N_hfAJE8byoXxmI8XUYd3zArr9RVzvyXMytdJnYAg2SXejDjNV0aCiaykVw0ys3EpLKcmZC97gGIejtsF7bA6cUm5OBjtRyzlpMLR3n449P/s320/Screen+Shot+2016-02-04+at+8.05.41+AM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">CDC</td></tr>
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symptoms may include low-grade fever, conjunctivitis, rash and joint pains. These symptoms usually occur 2-12 days following a bite by an infected mosquito and symptoms typically resolve within 2-7 days. <a href="http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html" target="_blank">The major concern is a link to microcephaly in infants born to mothers who became infected while pregnant.</a> <a href="http://www.bbc.com/news/world-latin-america-35368401" target="_blank">In Brazil nearly 4,000 cases of microcephaly have been reported since October 2015, a greater than 20 fold increase over background microcephaly incidence</a>. </div>
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<a href="https://www.washingtonpost.com/news/to-your-health/wp/2016/02/02/dallas-reports-case-of-zika-spread-through-sexual-transmission/" target="_blank">Zika virus infection was reported via sexual transmission (presumably via infected semen) in Texas</a>; this is the third case of reported Zika virus transmission via sexual transmission to date. The CDC is currently recommending women who are pregnant (or trying to become pregnant) avoid travel to areas where active Zika virus transmission is occurring. <a href="https://www.washingtonpost.com/news/to-your-health/wp/2016/02/02/dallas-reports-case-of-zika-spread-through-sexual-transmission/" target="_blank">They are also recommending that men who travel to transmission risk areas wear condoms for a time while in and after leaving these areas or abstain from sex</a>. Although Zika virus appears to clear fairly rapidly from the blood of infected people it is unclear how long it may persist in semen. More information is needed to help better counsel people who have been in areas with ongoing Zika virus transmission. </div>
Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-88979176522401056202016-02-02T12:39:00.002-08:002016-02-02T12:39:59.926-08:00Zika Virus Update<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2eAoYDwqwhpf9cExxGHZho2coKEOoynXWSLJ9VhRi0CDK3B_SiHa1I3OOhHdbqKKwmn7unUbyfv8ITEAT7OZp8-Su-inj9H-4pXskGFpXHj_tERyG4RMZIbtUej0pP2lDnlSYCniyNWBK/s1600/Screen+Shot+2016-02-02+at+3.09.12+PM.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2eAoYDwqwhpf9cExxGHZho2coKEOoynXWSLJ9VhRi0CDK3B_SiHa1I3OOhHdbqKKwmn7unUbyfv8ITEAT7OZp8-Su-inj9H-4pXskGFpXHj_tERyG4RMZIbtUej0pP2lDnlSYCniyNWBK/s320/Screen+Shot+2016-02-02+at+3.09.12+PM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Countries with Zika virus transmission (CDC)</td></tr>
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<a href="http://www.who.int/mediacentre/factsheets/zika/en/" target="_blank">Zika virus</a> is the latest mosquito-borne viral infection to emerge in the America, close on the heels of chikungunya which was first introduced in late 2013. <div>
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<a href="http://www.who.int/mediacentre/factsheets/zika/en/" target="_blank">Zika virus</a> is a flavivirus that was only recently introduced into South America and that is spreading rapidly throughout Latin America and the Caribbean. <i>Aedes </i>mosquitoes (especially <i>Aedes aegypti</i>) are day biting mosquitoes and transmit Zika virus (as well as dengue and chikungunya, among other viruses). It is believed that the incubation period for developing disease is a few days following a bite. People who develop symptoms may have mild fever, rash, conjunctivitis, headache, malaise and arthralgia. Of high concern is a significant uptick in the number of cases of microcephaly that have been detected in Brazil during the current outbreak; these appear to be related to Zika infection although a definitive causal link has not been established. Also, Zika infection has been linked to the rare, serious neurologic condition Guillain-Barre Syndrome. </div>
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The current outbreak has been declared <a href="http://www.bbc.com/news/health-35459797" target="_blank">an emergency by the World Health Organization (WHO)</a> and <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVW1hwJJFh8Fz1EfqaU_ASOXy4s8cDU4fYFa5PhCkU5PR1hM8GDfRrQQ4W-cXxOAVTEQT60ysKAZju_oYypzOlNukxNzqW_MvrsTVaBocU6xB3y8dBNEyYbzhdUgrXwaXJOP1KTc-7BqVt/s1600/Screen+Shot+2016-02-02+at+3.39.10+PM.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVW1hwJJFh8Fz1EfqaU_ASOXy4s8cDU4fYFa5PhCkU5PR1hM8GDfRrQQ4W-cXxOAVTEQT60ysKAZju_oYypzOlNukxNzqW_MvrsTVaBocU6xB3y8dBNEyYbzhdUgrXwaXJOP1KTc-7BqVt/s1600/Screen+Shot+2016-02-02+at+3.39.10+PM.png" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i>Aedes aegypti </i>mosquito (CDC)</td></tr>
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the <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm" target="_blank">U.S. Centers for Disease Control (CDC) are currently recommending pregnant women avoid travel to countries experiencing Zika virus transmission. </a></div>
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Global population growth and urbanization may have contributed to the Zika virus's emergence in the Americas. Like chikungunya just a few years before it, the virus appears to be spreading rapidly, especially in tropical and sub-tropical countries where <i>Aedes</i> mosquitoes exist in abundance. </div>
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Unfortunately treatment of Zika is symptom based; no specific antiviral therapies or vaccines exist at this point. Mosquito control and bite avoidance strategies will be critical in dealing with Zika virus. Looking to the future, other viruses that are transmitted by the same mosquitos could emerge; global public health planning should anticipate these events and invest in strategies to reduce such emergence. </div>
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Some excellent resources can be found online at the <a href="http://www.who.int/mediacentre/factsheets/zika/en/" target="_blank">WHO site</a> as well at <a href="http://www.cdc.gov/zika/hc-providers/index.html" target="_blank">CDC's site</a>. </div>
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Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-17361482147732950422015-11-20T11:28:00.000-08:002015-11-20T11:29:36.016-08:00The Crisis of Antibiotic Resistance: Are We Entering the Post-Antibiotic Era?<div class="separator" style="clear: both; text-align: center;">
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<i>I had a wonderful opportunity to speak at a hospital in the Richmond community this week about antibiotic resistance and stewardship; I was asked to speak by that health system's Antimicrobial Stewardship Program as part of their activities around "Get Smart About Antibiotics" week. I was asked to write up my talk so they could share it with their health system. My write-up is below. </i></div>
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The Crisis of Antibiotic Resistance: Are We Entering the
Post-Antibiotic Era?</div>
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In November we celebrate the CDC’s “Get Smart About
Antibiotics Week,” an event designed to raise awareness about the crisis of
antibiotic resistance and to outline possible solutions. To answer the question
of whether we are entering a post-antibiotic era: in a word, yes. But there is
hope. <o:p></o:p></div>
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Antibiotics are potentially life-saving compounds, and their
discovery has been critical to many of the medical and surgical advances we
have seen in the past 75 years. Without antibiotics patients would not be able
to survive the infectious complications of things like chemotherapy, organ
transplantation and immune suppression for rheumatologic diseases. <o:p></o:p></div>
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We truly are at a crisis point with antibiotic resistance,
especially for multi-drug resistant gram negative rods (MDR GNR). For many
patients with MDR GNR infections we have essentially returned to 19<sup>th</sup>
century medicine: in the absence of antibiotics we are left with pursuing
aggressive ‘source control’ for infected tissues, when possible. An example
would be a patient with a diabetic foot infection: whereas surgery and
antibiotics can often cure these infections, a patient with an infection with a
pan-resistant GNR may require amputation. This is not a doomsday scenario, this
is reality for many of our patients in 2015. <o:p></o:p></div>
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The CDC estimates that 2 million people acquire infections
with antibiotic-resistance bacteria yearly and 23,000 die as a direct result of
these infections. It is estimated these infections lead to upwards of 35
billion dollars in excess healthcare costs in the United States alone. These
statistics do not fully capture the scope of the problem, however, as the
morbidity associated with these infections can be significant. <o:p></o:p></div>
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Here is the problem in a nutshell: antibiotic use selects
for resistant organisms and the emergence of resistance has outpaced the
development of new antibiotics. Most of the antibiotics in use today are
natural products that organisms have been using to battle one another for
millennia; we have ‘discovered’ these and adopted them for use in humans and
animals. The antimicrobial ‘resistome’ (the resistance capacity of organisms to
overcome antibiotics) already exists in nature, presumably for most if not all
antibiotics. This is why we see resistance emerge fairly rapidly whenever ‘new’
antibiotics are deployed. <o:p></o:p></div>
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Antibiotic use extends far beyond therapeutic use in humans.
It is estimated that 70% of antibiotic use is in animals for non-therapeutic
use. Antibiotics are often used in the animal industry to grow larger, fatter
animals faster. Any solutions to the crisis of antibiotic resistance have to
span the continuum of use in both animals and humans. <o:p></o:p></div>
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Our relationship with the microbes who live on and inside is
not well understood; there is increasing evidence that there may be a symbiotic
relationship with our ‘microbiome,’ however. There are an astounding 10
bacterial cells for every 1 human cell in the human body. There is some
intriguing data that suggests altering our microbiome with antibiotics can lead
to things like allergies and obesity. Antibiotics should not be seen as
innocuous. <o:p></o:p></div>
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It is estimated 50% of all antibiotic use in human medicine
is unnecessary. The reasons for this are myriad. Front-line providers need
rapid, accurate, affordable tests to diagnose the etiology of things like upper
respiratory infections and urinary tract infections. We also need better
protocols for treating various infectious conditions informed by properly performed
clinical trials. We need better surveillance technologies to identify
antibiotic resistance and standardized, risk adjusted data on antibiotic
prescribing at the provider level. <o:p></o:p></div>
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Beyond all of the above we need new antibiotics to combat
drug-resistant bacteria. To date there is no new anti-GNR compound with a novel
mechanism of action in the antibiotic creation ‘pipeline.’ Although the FDA
approval mechanism for antibiotics has become more streamlined in recent years,
we have seen far fewer antibiotics in development. Many pharmaceutical
companies have abandoned antibiotic development altogether. <o:p></o:p></div>
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So what can be done in 2015 to combat this issue by individual
providers? First and foremost we should strive to prevent infections. Vaccinate
patients according to national guidelines, wash your hands before and after
patient contact and use appropriate contact precautions in the inpatient
environment. We can also prevent the emergence of antibiotic resistance by
optimizing our antibiotic use, especially for inpatient medicine. Record the
indication, dose and expected duration when ordering antibiotics. Take a daily
‘time out’ for each patient on antibiotics to re-assess their use and continued
need. Be aggressive with diagnostics early on to aid in de-escalation later.
And perhaps most importantly partner with your Antimicrobial Stewardship Team.
These teams exist to assist you in optimizing antibiotic use and can be a
terrific resource. <o:p></o:p></div>
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Many of our patients have already entered the
‘post-antibiotic era.’ The development of antibiotic resistance has outpaced
new drug development. The issue is complex but first and foremost we need to be
aware of just how dire the problem is and that we all have a role to play in
its solution. It has been 75 years since we saw the widespread deployment of
antibiotics. Unless major changes occur in antibiotic use and production we are
in danger of fully returning to 19<sup>th</sup> century practice for many of
our patients. </div>
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<o:p></o:p></div>
Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0Richmond, VA, USA37.5407246 -77.436048137.339233099999994 -77.758771599999989 37.7422161 -77.1133246tag:blogger.com,1999:blog-3059321477138638966.post-67427554006033469542015-11-10T04:50:00.002-08:002015-11-10T04:50:46.230-08:00PK/PD in Clinical Practice <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4W8IIgH6NWZ78ISLDk5vkHOBILti7B3r_4ACU88jUK0SCfFAy_w4_dZMuzV18KfbgK0ozxVLe-9ISnKbTO6bcVhkJ2Gz1koKEtZbIZx3XG30CVltwfFixoj_N1kd2BUAOvegx12Pplgi_/s1600/CRE.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4W8IIgH6NWZ78ISLDk5vkHOBILti7B3r_4ACU88jUK0SCfFAy_w4_dZMuzV18KfbgK0ozxVLe-9ISnKbTO6bcVhkJ2Gz1koKEtZbIZx3XG30CVltwfFixoj_N1kd2BUAOvegx12Pplgi_/s320/CRE.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Multi-drug resistance gram-negative rods (CDC)</td></tr>
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There is a <a href="http://www.ncbi.nlm.nih.gov/pubmed/26105168" target="_blank">great article</a> in the November 1st issue of Clinical Infectious Diseases where Labreche and colleagues discuss recent updates on using pharmacokinetics-pharmacodynamics (PK/PD) in antimicrobial susceptibility testing.<br />
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Given the current crisis of gram-negative resistance and the paucity of new drugs in development it is critical that physicians learn to optimize their use of the drugs left in our armamentarium. For most antibiotics/ organisms susceptibility results are simply listed as "S"usceptible, "I"ntermediate, or "R"esistant. Oftentimes the Minimum Inhibitory Concentration (MIC) of the organism is not provided; even when these values are provided they are difficult for most physicians to interpret. What is needed is a better understanding of PK/PD principles as well as how to navigate the complex recommendations of the many organizations providing antibiotic susceptibility cutoffs.<br />
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Labreche and colleagues provide a nice overview of core PK/PD principles and also discuss the different agencies that provide breakpoints for different organisms and drugs (FDA, CLSI, EUCAST). For the latter, differences in how the organizations come up with recommendations are highlighted. Several useful examples of recent changes are provided and how these changes can be applied to clinical practice.Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-26633458714882873362015-06-11T20:51:00.001-07:002015-06-17T17:32:35.217-07:00VCU GH2DP Outreach Trip to Yoro, Honduras: Summary<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">Traveling to La Hicaca</td></tr>
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Today we returned to San Pedro Sula after a week up in the mountains in rural Yoro, Honduras.<br />
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Since 2005 we have been working with approximately 17 villages with little to no access to medical care.</div>
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<tr><td class="tr-caption" style="text-align: center;">Medicine Clinic in Lomitas</td></tr>
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With the aid of our many local, regional, national and international partners we were able to see approximately 700 patients this week. In addition we distributed approximately 90 water filters (each of which will provide an entire household with clean drinking water for 2 years), helped facilitate cervical cancer screening for 80 women and completed a project focused on assessing knowledge and risk factors for dengue and chikungunya infection as well as projects focused on the effectiveness of a new chlorination system and several novel clean water technologies. </div>
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<tr><td class="tr-caption" style="text-align: center;">Assembling water filters</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Testing new water catchment device</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">With Dr. Pat Mason and Dr. Ana Sanchez working on our deworming project</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Internal Medicine team, Lomitas</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Dr. Jason Cook working on water chlorination system project</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">GH2DP Outreach Team, La Hicaca</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">GH2DP Pathway Residents and Student Scholars</td></tr>
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Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0Hilton Princess San Pedro Sula Avenida Circunvalacion, San Pedro Sula15.499144 -88.037624tag:blogger.com,1999:blog-3059321477138638966.post-10128316679567750522015-06-05T04:37:00.001-07:002015-06-05T04:37:18.790-07:00GH2DP Outreach Trip: Day 2<div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgl2v8_WBFCFulXg8P_AuK4vIg7tl4VSPkfM8rj5-UrjFo0-kJSdvs0oytwQpTRPpJz02g785yVk9_xnUkFQE2zQwEbQy6WcFss3xe-vsZlf25v6qXOqI-eTGQISiV7ITQ5U4lknSWdfR2g/s640/blogger-image--1058871665.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgl2v8_WBFCFulXg8P_AuK4vIg7tl4VSPkfM8rj5-UrjFo0-kJSdvs0oytwQpTRPpJz02g785yVk9_xnUkFQE2zQwEbQy6WcFss3xe-vsZlf25v6qXOqI-eTGQISiV7ITQ5U4lknSWdfR2g/s640/blogger-image--1058871665.jpg"></a></div>Last night we arrived in Olanchito late and spent several hours preparing medications and supplies. Today we leave to go to La Hicaca where our first clinic will be held this afternoon.<div><br></div><div>A major focus of our health outreach work focuses on de-worming. Last year stool testing revealed a high prevalence of whipworm infection despite de-worming with a single dose of albendazole twice yearly. In addition to continuing surveillance we have changed our de-worming protocol to better target whipworm and have initiated a new de-worming tracking project.</div><div><br></div><div>After this morning there will likely be no new posts until we get back from the mountains. Will share more about our trip when we return.</div><div><br></div><div><br></div>Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0Olanchito Olanchito15.495105 -86.568758tag:blogger.com,1999:blog-3059321477138638966.post-70690203149711936142015-06-04T10:22:00.001-07:002015-06-04T10:22:34.729-07:00GH2DP Outreach Trip to Yoro, HondurasToday is day one of our outreach trip to rural Yoro, Honduras, on a medical and public health outreach trip with VCU's Global Health and Health Disparities Program (GH2DP). <div><br></div><div><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdoqwZGVBwERDzje2aS1rOu8VOy2BtxWt_lgZ0PWVs_vjwpndXGEgUPD9af_1OsaXn8-48lu6F1IKGF9RMp5oF4lQKvgwlvRDzlGXqiW0d_TWYj22chQzp1L5lfbsd8E6xYSeNf7Bc7gF8/s640/blogger-image-269545066.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdoqwZGVBwERDzje2aS1rOu8VOy2BtxWt_lgZ0PWVs_vjwpndXGEgUPD9af_1OsaXn8-48lu6F1IKGF9RMp5oF4lQKvgwlvRDzlGXqiW0d_TWYj22chQzp1L5lfbsd8E6xYSeNf7Bc7gF8/s640/blogger-image-269545066.jpg"></a></div>The U.S. contingent of our group left early this morning and has arrived in San Pedro Sula. In addition to our group we have approximately 950 pounds of gear and supplies we will transport to Olanchito and organize tonight.</div><div><br></div><div>Our plan is to meet the rest of our group and transport our team and supplies up to the rural, mountainous village of La Hicaca tomorrow. From here we will stage our medical and public health outreach work.</div><div><div><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj36pnVVfpd1rftzXAZSaU75TJAy0uP2w7EqqBKfuDxOjnqBK7qa0NAQ1qDMhn2T1l4mfKxccTGk6zX0YWr1v9c6KZDYR9bgKUT_zg7P9_rMq-eiKZI_0W3AVBl3iL4tc5G9Jy3yrY6A65n/s640/blogger-image-286506432.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj36pnVVfpd1rftzXAZSaU75TJAy0uP2w7EqqBKfuDxOjnqBK7qa0NAQ1qDMhn2T1l4mfKxccTGk6zX0YWr1v9c6KZDYR9bgKUT_zg7P9_rMq-eiKZI_0W3AVBl3iL4tc5G9Jy3yrY6A65n/s640/blogger-image-286506432.jpg"></a></div><br></div><div><br></div></div>Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0Ramón Villeda Morales International Airport La Lima15.446054 -87.931609tag:blogger.com,1999:blog-3059321477138638966.post-76280556794748417692015-06-02T17:37:00.000-07:002015-06-02T17:37:03.940-07:00GH2DP Outreach Trip to Rural Yoro, Honduras: June 2015 <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9tB5gYKR1csT_kT8GJgDblIeevPdvpK0gQCGwCcVnBcPXuKnu1LlkLWAPfWOkhpNCJH5mfKXBU5O32N1YQhFBlryMArCRWv5BjMlV99noRxM3PZSOy5NSb8lmnxOOaZ9X_KXzn138_lON/s1600/Screen+Shot+2015-06-02+at+8.19.40+PM.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9tB5gYKR1csT_kT8GJgDblIeevPdvpK0gQCGwCcVnBcPXuKnu1LlkLWAPfWOkhpNCJH5mfKXBU5O32N1YQhFBlryMArCRWv5BjMlV99noRxM3PZSOy5NSb8lmnxOOaZ9X_KXzn138_lON/s320/Screen+Shot+2015-06-02+at+8.19.40+PM.png" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Students and residents preparing water<br />filters in Lomitas</td></tr>
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Our upcoming <a href="http://gh2dp.vcu.edu/Honduras_Outreach.html" target="_blank">outreach trip to rural Yoro, Honduras</a> is fast approaching. Our team, in collaboration with the local Ministry of Health and many local, regional and international partners, helps provide care to approximately 1,200 people from 17 villages. We have been working collaboratively to provide care in this region for the past 10 years.<br />
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Our team is once again fairly large and includes attending <br />
physicians (pediatricians and internists), medical and pediatric residents, an attending pharmacist, students from medicine, pharmacy and public health in addition to an undergraduate engineering student and numerous other individuals. We are once again collaborating with colleagues from Brock University and the National Autonomous University of Honduras on a project exploring the local prevalence of soil-transmitted helminth (worm) infection.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJ_LpU_JMGwnyJ0UIM-iZCqBcWojrpmneJXiZJ2RmuYwjgdb8Fzlj1lyJcDE3TIgfnmn0DYiQ8bfDb7gQo4MSkNq8ZiaTloQP4skYsanRoRNj_lO0vYgj8_5Ho1KNqRCxrt0knou41H5LF/s1600/Screen+Shot+2015-06-02+at+8.12.19+PM.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJ_LpU_JMGwnyJ0UIM-iZCqBcWojrpmneJXiZJ2RmuYwjgdb8Fzlj1lyJcDE3TIgfnmn0DYiQ8bfDb7gQo4MSkNq8ZiaTloQP4skYsanRoRNj_lO0vYgj8_5Ho1KNqRCxrt0knou41H5LF/s320/Screen+Shot+2015-06-02+at+8.12.19+PM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Engineers Without Borders students with a novel rain<br />water catchment device in La Hicaca </td></tr>
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We will also get to see first-hand numerous other projects we have been longitudinally collaborating on: an improved cookstove project we have been working on with a local nonprofit (the Pico Bonito Foundation) as well as the placement of numerous new latrines. We will also get to see the new chlorination systems that were installed this past year. Six of the villages we serve (and approximately 40% of the population we serve) have access to water directly in their homes via a network of pipes that gravity-feed water from five different cisterns which are themselves fed by a river deeper in the mountains. We collaborated with local partners to install chlorination systems that slowly leach chlorine into water at the level of the cistern. We have had a water filter project in the region since 2008 that provides clean drinking water to the entire region. We know from our prior work these locally-created filters are clinically and microbiologically effective. Since the new chlorination systems have replaced the filters for the villages where these were installed we have a project that will look at the microbiologic and clinical effectiveness of these new systems. Additionally, we will also be testing water (at the level of individual homes) for chlorine content.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTOvE6_NJjXki46NBTyHQn5-eM8CcvFH7MXCuZUn-Y1xNcFPAEPcagB3AnJvY_KNz1RCjRdLESB_IjAHKqJUk7pmQMSDiWgUjAN6H8paKxRZOP1nJfPh3aSAhSFRiTNXcAGJ7njOI-z9cX/s1600/Screen+Shot+2015-06-02+at+8.12.36+PM.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTOvE6_NJjXki46NBTyHQn5-eM8CcvFH7MXCuZUn-Y1xNcFPAEPcagB3AnJvY_KNz1RCjRdLESB_IjAHKqJUk7pmQMSDiWgUjAN6H8paKxRZOP1nJfPh3aSAhSFRiTNXcAGJ7njOI-z9cX/s320/Screen+Shot+2015-06-02+at+8.12.36+PM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With colleagues from the National Autonomous University<br />of Honduras and Brock University</td></tr>
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We have once again partnered with <a href="https://vcu.collegiatelink.net/organization/engineerswithoutbordersvcu" target="_blank">VCU's Engineers Without Borders</a> student chapter to trial several novel clean water devices.<br />
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We also have a study focused on knowledge, attitudes and risk factors for the mosquito-borne diseases dengue and chikungunya.<br />
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In terms of our direct clinical work we have modified our typical clinic schedule somewhat in an attempt to be more accessible to patients in outlying areas. The population we serve is spread across a wide geographic area and some people travel 6 to 7 hours one way by foot to see us; unfortunately the infrastructure only provides a few road access points to facilitate moving our group and supplies. We hope our new schedule will allow us to serve more people.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqkzLvD9p0hUbmzrErTyG9bkztH0MTERtunaqJGjogqxsFANvW5iVMVQz31ePKhZ6BSX-J8jHECawiNwhGS_jvetiS1WNBtMR0T3wcq7bXPVX3sQtt5w8rfu5AMraU0LanAqGtndNJ8pBe/s1600/Screen+Shot+2015-06-02+at+8.13.46+PM.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqkzLvD9p0hUbmzrErTyG9bkztH0MTERtunaqJGjogqxsFANvW5iVMVQz31ePKhZ6BSX-J8jHECawiNwhGS_jvetiS1WNBtMR0T3wcq7bXPVX3sQtt5w8rfu5AMraU0LanAqGtndNJ8pBe/s320/Screen+Shot+2015-06-02+at+8.13.46+PM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Testing water for microbiologic contamination </td></tr>
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This year we will also be trialing a new education project focused on our student and resident trainees. This focuses on core content highlighted during the trip (focusing on demography, tropical dermatology, tropical infectious diseases and chronic disease screening).<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTOtZdZNDQsoSwpy1fRTBrujZAN_yzHEYbSgpmTIcdG-HZVOrO4NU2d2EBuwRqC-G-PYZI7CeD6zzKOrsG5-eK_IhigbqH82WDpg3V6j1yk873PTfEkMO-upxLtruFfP1wwd4ATGiC7MLZ/s1600/Screen+Shot+2015-06-02+at+8.18.07+PM.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTOtZdZNDQsoSwpy1fRTBrujZAN_yzHEYbSgpmTIcdG-HZVOrO4NU2d2EBuwRqC-G-PYZI7CeD6zzKOrsG5-eK_IhigbqH82WDpg3V6j1yk873PTfEkMO-upxLtruFfP1wwd4ATGiC7MLZ/s320/Screen+Shot+2015-06-02+at+8.18.07+PM.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Clinic in Lomitas </td></tr>
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We have a fantastic group this year who have worked very hard to prepare for this trip. I am absolutely thrilled to work with and learn from this amazing group of students, residents and our many community, regional and international partners.<br />
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I will blog about our trip as cellular access allows; we also will be tweeting about the trip (#GH2DP).Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-64092468081383159302015-04-20T16:31:00.001-07:002015-04-20T16:31:17.402-07:003rd Annual VCU Global Health Showcase Recap<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6CHZOM1He_OJa6p7Qya7KC52Jb7C7el9mevQLP2CX2PY2dV9kV_RCHioqGsKPjO23MLV2wftgeIIUlHhXQPKw67TVafk1cEXyn7798vKwWaMtFmKhZ5ALKEjhvh8_dYcy4JyJF62UeTBW/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0005.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6CHZOM1He_OJa6p7Qya7KC52Jb7C7el9mevQLP2CX2PY2dV9kV_RCHioqGsKPjO23MLV2wftgeIIUlHhXQPKw67TVafk1cEXyn7798vKwWaMtFmKhZ5ALKEjhvh8_dYcy4JyJF62UeTBW/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0005.JPG" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Kerkering speaking on the West Africa Ebola outbreak</td></tr>
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Today was VCU's <a href="http://www.global.vcu.edu/ghs2015/" target="_blank">3rd Annual Global Health Showcase</a>, an opportunity for people around VCU and the greater Richmond community to share and discuss global health projects.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlv7B2CAHhM_r4oIwuvAD51MxijnkIb0mNKTLoS8gC5kiatSDkSKPY-BBR2jNAYJjQjMdHLVsiZLrR9SV1OqYl85FKljsVewWYc4edbFAbVeMMlIEJCixaQgbHodklsQW_Etbaab45fh-d/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0002.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlv7B2CAHhM_r4oIwuvAD51MxijnkIb0mNKTLoS8gC5kiatSDkSKPY-BBR2jNAYJjQjMdHLVsiZLrR9SV1OqYl85FKljsVewWYc4edbFAbVeMMlIEJCixaQgbHodklsQW_Etbaab45fh-d/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0002.jpg" height="234" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With Dr. Bearman and GH2DP residents and students</td></tr>
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The day started with a keynote presentation from Dr. Thomas Kerkering on his work treating Ebola patients in West Africa. Dr. Kerkering is a <a href="http://www.vcu.edu/" target="_blank">VCU</a> alumnus and his talk was both moving and compelling. He showed excerpts from a <a href="http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/" target="_blank">documentary</a> on the early days of the current Ebola outbreak in West Africa (this documentary can be found <a href="http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/" target="_blank">here</a>).<br />
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Subsequently there were several 'break-out' <br />
sessions: one discussing getting involved in global health research, one focused on training opportunities for medical students and residents and one focused on providing healthcare in resource-limited settings.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3K29FoUL3cXFwrbAVmqGX5U3gbIUKrom9z0cIVZ8IU0dknkmyoaOIXce9R1I3VXF3PLHhkXWkFcwawQ1Zg6RdzxSvJ9iK_u5Oc_i02t_lBeALL2-2WgIyroSyV4pQ8maK_HvkwrLo2iZT/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0003.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3K29FoUL3cXFwrbAVmqGX5U3gbIUKrom9z0cIVZ8IU0dknkmyoaOIXce9R1I3VXF3PLHhkXWkFcwawQ1Zg6RdzxSvJ9iK_u5Oc_i02t_lBeALL2-2WgIyroSyV4pQ8maK_HvkwrLo2iZT/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0003.JPG" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Viewing posters</td></tr>
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There was an excellent poster section exploring global-health related research from around <a href="http://www.vcu.edu/" target="_blank">VCU</a>. <a href="http://www.vcu.edu/" target="_blank">VCU's</a> <a href="http://gh2dp.vcu.edu/Home.html" target="_blank">Global Health & Health Disparities Program</a> was well represented with our students and residents presenting seven different projects.<br />
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The day ended with an excellent session focused on some of the ethical challenges of getting involved in global health work.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdAsXD7lBHZvYr3TzjzASt3PAr7vDgaQCw5reoX-gkbvbt3F2E0hDA_zU1fr2rpxWVJMZ0KyKHI_BPlFAoPcr7YGZ6qWn2IAKo8E5z4mJ_7kQEIw3lhJpnCQctlNXnUYUgyZwo2GEhzLYP/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0004.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdAsXD7lBHZvYr3TzjzASt3PAr7vDgaQCw5reoX-gkbvbt3F2E0hDA_zU1fr2rpxWVJMZ0KyKHI_BPlFAoPcr7YGZ6qWn2IAKo8E5z4mJ_7kQEIw3lhJpnCQctlNXnUYUgyZwo2GEhzLYP/s1600/2015,+4+%5BApril+20%5D-GHS20150420_0004.JPG" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With Dr. Bearman and current GH2DP Pathway Residents</td></tr>
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Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-86993520113607166892015-04-13T03:07:00.000-07:002015-04-13T03:07:11.202-07:003rd Annual VCU Global Health Showcase: Making it Work, Getting it Right<div class="separator" style="clear: both; text-align: center;">
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The <a href="http://www.global.vcu.edu/ghs2015/" target="_blank">3rd annual Virginia Commonwealth University Global Health Showcase</a> is coming up on April 20, 2015. This is an all day event featuring an exciting keynote from Dr. Tom Kerkering discussing his experience with the Ebola outbreak in West Africa, several breakout sessions and a poster session featuring global-health related work from trainees across the university. This year's meeting is called "Making it Work, Getting it Right." The theme of the meeting is giving students and faculty key tools to engage in global health work.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfenShq3stFHWkdz2qj-pUZ0e5WRNmU0MxffADzaw62fi4IJUNqAq1xDSSDTPr1emgZ2XObY4SpZkYwZ5jL_mfsktrAzpiuPVmYyd5hHQK-QrW2AqJnknGwm01JVUGRs7cefClwbN-YAap/s1600/Screen+Shot+2015-04-13+at+6.02.44+AM.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfenShq3stFHWkdz2qj-pUZ0e5WRNmU0MxffADzaw62fi4IJUNqAq1xDSSDTPr1emgZ2XObY4SpZkYwZ5jL_mfsktrAzpiuPVmYyd5hHQK-QrW2AqJnknGwm01JVUGRs7cefClwbN-YAap/s1600/Screen+Shot+2015-04-13+at+6.02.44+AM.png" height="208" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">VCU EWB students trailing a novel water catchment device<br />in Yoro, Honduras, June 2014</td></tr>
</tbody></table>
Prior showcases have been a wonderful opportunity to network, share ideas and build new relationships. The first showcase led to our program's (the <a href="http://gh2dp.vcu.edu/Home.html" target="_blank">Global Health & Health Disparities Program, GH2DP</a>) current partnership with <a href="https://vcu.collegiatelink.net/organization/engineerswithoutbordersvcu" target="_blank">VCU's Engineers Without Borders (EWB) student chapter</a>. This relationship has led to the development of several novel clean water technologies for use in rural Latin America as well as helped support or ongoing <a href="http://gh2dp.vcu.edu/Honduras_Outreach.html" target="_blank">clean water campaign in Yoro, Honduras</a>.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm5HUOaeFGLa0TcdBRbiEpO7a_dLo4hmksUKJLHS-EZT_3Pe1BwuoOhyphenhyphenPxGCZ6gWUzgXx_3e5jCtSJEi8NYP2BOzQUAPrAWvGzrjEKEW0JFMiZ0MJ4qayU_3dmjyyJyUq8ziPTbZyQvmn3/s1600/Screen+Shot+2015-04-13+at+6.02.50+AM.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhm5HUOaeFGLa0TcdBRbiEpO7a_dLo4hmksUKJLHS-EZT_3Pe1BwuoOhyphenhyphenPxGCZ6gWUzgXx_3e5jCtSJEi8NYP2BOzQUAPrAWvGzrjEKEW0JFMiZ0MJ4qayU_3dmjyyJyUq8ziPTbZyQvmn3/s1600/Screen+Shot+2015-04-13+at+6.02.50+AM.png" height="320" width="238" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">VCU EWB students trailing a new biased filter,<br />Richmond, VA, 2015</td></tr>
</tbody></table>
It is not too late to register and come out for the <a href="http://www.global.vcu.edu/ghs2015/" target="_blank">showcase</a> on April 20th! Details about the showcase (including the agenda) can be found <a href="http://www.global.vcu.edu/ghs2015/" target="_blank">here</a>.Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-23753133722321578492015-03-23T08:25:00.000-07:002015-03-23T08:25:15.856-07:00Global Health Resources Guidebook for Students, Residents and Fellows<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx06mGLi1sP7ME_KzC0ONLwMxzZT4CiqDQ_-Nzu18HW11k0rNZiNnNF13q_MGIdXRn4JWOa1QODYgfpnxUdgPJjC5cAqS4Um6XLt1wx8VXod64UfpYH0B6gPaHssXlk5wEZXSrlxhDw1RR/s1600/Screen+Shot+2015-03-23+at+6.07.39+AM.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx06mGLi1sP7ME_KzC0ONLwMxzZT4CiqDQ_-Nzu18HW11k0rNZiNnNF13q_MGIdXRn4JWOa1QODYgfpnxUdgPJjC5cAqS4Um6XLt1wx8VXod64UfpYH0B6gPaHssXlk5wEZXSrlxhDw1RR/s1600/Screen+Shot+2015-03-23+at+6.07.39+AM.png" height="320" width="247" /></a></div>
In preparation for a 'breakout' session at the upcoming 3rd Annual Virginia Commonwealth University Global Health Showcase I put together a <a href="http://www.gh2dp.vcu.edu/Global_Health_Education_Resources_files/Resources%20for%20Trainees%20Interested%20in%20Global%20Health_Stevens_2015_3_20_vs6.pdf" target="_blank">resource guidebook</a> for students, residents and fellows interested in global health; this can be found <a href="http://www.gh2dp.vcu.edu/Global_Health_Education_Resources_files/Resources%20for%20Trainees%20Interested%20in%20Global%20Health_Stevens_2015_3_20_vs6.pdf" target="_blank">here</a>.<br />
<br />This '<a href="http://www.gh2dp.vcu.edu/Global_Health_Education_Resources_files/Resources%20for%20Trainees%20Interested%20in%20Global%20Health_Stevens_2015_3_20_vs6.pdf" target="_blank">book</a>' contains a number of links to great online resources: from lists of post-graduate training programs in global health to international and domestic volunteer opportunities to lists of great global-health related books and journals. Additionally, it links to a number of free (!!) online training resources for global health.<br />
<br />
<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-23495771983626329202015-03-05T10:43:00.000-08:002015-03-05T10:45:23.062-08:00Special Guest Blog Post from Nadia Masroor: February GH2DP Outreach Trip to Yoro, Honduras <i>This is a special guest blog post by Nadia Masroor, who has joined us on the last few health outreach trips to Yoro, Honduras, and who recently returned from Honduras: </i><br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidRGFfeR3sGPEKM81e3Mzpx_BlANGuLZGDIXBWA9zWv_0uclUxKWW7wuRiscA0g9YZGTxDE4_2K3DEZuRZpUVqW85J6OVV5GLdfuwaUhSP4QvHSwZKgDlb8alW3FWMfitMka6HTVTj106T/s1600/pic1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidRGFfeR3sGPEKM81e3Mzpx_BlANGuLZGDIXBWA9zWv_0uclUxKWW7wuRiscA0g9YZGTxDE4_2K3DEZuRZpUVqW85J6OVV5GLdfuwaUhSP4QvHSwZKgDlb8alW3FWMfitMka6HTVTj106T/s1600/pic1.jpg" height="320" width="240" /></a><span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Our February trip to Olanchito
and La Hicaca provided some excellent feedback on several ongoing projects. On Thursday
February 12<sup>th</sup>, Dr. Bearman and I had the wonderful opportunity to
meet with Padre Pedro and the rest of the Catholic priests in Olanchito for
lunch.<o:p></o:p></span></div>
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<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Afterwards,
Dr. Bearman, Padre Pedro, and I met with the Pico Bonito Foundation to discuss their
progress on current projects. Pico Bonito has successfully installed
chlorination systems in La Hicaca, Chorro Viento, and Puerto Rico. Those living
in these three villages are encouraged to use the chlorinated water cisterns
for their water supply. In order to determine the efficacy of chlorination, the
2015 brigade team will plate and incubate chlorinated water to assess
microbiological growth. As for those who do not have access to the cisterns, an
estimated 90-100 filters will need to be distributed in June 2015.<o:p></o:p></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFLU-6nD7GBhPTlSx6ZmMOQBp3896dEqvf0x8tKUlStKTpERu2anhMHxpL-MpkyCVdJKaRrZyMNFsxMhfGNzAsYQIK76nnlz08acwL83ZS8WUfSI5xDNOJNqGqoACHFop0ld4wMdaR9Y1h/s1600/pi2.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFLU-6nD7GBhPTlSx6ZmMOQBp3896dEqvf0x8tKUlStKTpERu2anhMHxpL-MpkyCVdJKaRrZyMNFsxMhfGNzAsYQIK76nnlz08acwL83ZS8WUfSI5xDNOJNqGqoACHFop0ld4wMdaR9Y1h/s1600/pi2.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Hike to Chorro Viento</td></tr>
</tbody></table>
<span style="font-family: "Cambria","serif"; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">The
Pico Bonito Foundation has recently installed new cook stoves in many of the
homes in LaHicaca. According to the foundation, each cook stove costs about
$100. We plan to continue this project by funding Pico Bonito to install
another 15-20 cook stoves this year. Padre Pedro and Rosa, who is the nurse
providing care to the people of La Hicaca and surrounding villages, will determine
which impoverished homes are most in need of cook stoves. In conjunction with
the cook stoves, the Pico Bonito foundation has also agreed to install new
latrines for the people in Sector La Hicaca. Approximately 15-20 latrines,
which cost $100 each, are projected to be built throughout the village this
year. Lastly, in order to replace the deteriorated school latrines, we have
requested 4 new latrines to be constructed as well, which have been estimated
to cost $800-$1000. To say the least, our meeting with the Pico Bonito
Foundation has enlightened us on the plethora of projects we can initiate in
order to improve living conditions in La Hicaca and surrounding villages.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgf0Erkhl5DD1-iOe0uPAcIBV9UcuZ6v2TBe0dCrE1gSLrrPJQGDBs4heTavd0qxuUeb2q4sY3cBK4nP9cjZJxBihheWAIX4m6Lzxjv2JqYM_RE3ZzEb4k-sfV-FbhJzVwDJ70GGB0Q-r1b/s1600/pic3.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgf0Erkhl5DD1-iOe0uPAcIBV9UcuZ6v2TBe0dCrE1gSLrrPJQGDBs4heTavd0qxuUeb2q4sY3cBK4nP9cjZJxBihheWAIX4m6Lzxjv2JqYM_RE3ZzEb4k-sfV-FbhJzVwDJ70GGB0Q-r1b/s1600/pic3.jpg" height="320" width="240" /></a></div>
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<span style="font-family: Cambria, serif; text-indent: 0.5in;">Later that day we met with Dr. Alma Nunez from
the Ministry of Health to discuss the June 2015 brigade. Historically, La
Hicaca has been the clinic site for 3 days and Lomitas has been the clinic site
for 2 days. This year, however, Padre has advised spending 2.5 days in La
Hicaca and 2.5 days in Lomitas. By increasing clinic time in Lomitas, Dr. Nunez
and Padre hope that the brigade will be able to extend its care to more people.
The total number of brigade clinic sessions will remain the same. In addition,
Padre Pedro will work with the Ministry of Health to provide dental services
for 3 days, covering both La Hicaca and Lomitas.</span></div>
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<span style="font-family: Cambria, serif; text-indent: 0.5in;">Based on Brock University’s findings from the
June 2014 brigade, the majority of the population suffers from Trichura, which
cannot be effectively treated with albendazole alone. Thus during this year’s
brigade we will be distributing oxantal pamoate in addition to the albendazole
to provide enhanced Trichura coverage. Padre Pedro has taken on the task to
inquire and purchase both the albendazole and the oxantal pamoate.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggVVs84M7fXK87qaQ2yNV6jVtrJ63gRfp_PhGNfgQpuGm5Lj3VovU19YFuAfy49f19qnBKIod7_hRul_3I4u9mGTqjjAZVFoBnONd5OKIlacKubBPS7gMj4Ji_tNGbF45RVnS_fgTokFLK/s1600/pic4.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggVVs84M7fXK87qaQ2yNV6jVtrJ63gRfp_PhGNfgQpuGm5Lj3VovU19YFuAfy49f19qnBKIod7_hRul_3I4u9mGTqjjAZVFoBnONd5OKIlacKubBPS7gMj4Ji_tNGbF45RVnS_fgTokFLK/s1600/pic4.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Cistern in Chorro Viento</td></tr>
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<span style="font-family: Cambria, serif; text-indent: 0.5in;">Dr. Nunez
has proposed aggressively promoting the brigade via Radio Catolica broadcast in </span>order to increase awareness and participation. Therefore, Padre Pedro will
collaborate with Radio Catolica in order to provide the brigade dates and
details about the services offered. We hope to see an increase in the number of
people who attend the brigade in June.</div>
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<span style="font-family: Cambria, serif; text-indent: 0.5in;">On Friday
February 13</span><sup style="font-family: Cambria, serif; text-indent: 0.5in;">th</sup><span style="font-family: Cambria, serif; text-indent: 0.5in;">, we traveled to La Hicaca so that could meet with Rosa
in el Centro de Salud. Rosa graciously agreed to continue sanitation education
and to take on the latrine and cook stove projects with Pico Bonito. She has
also requested an additional 300 speculums for cytology exams.</span></div>
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<span style="font-family: Cambria, serif; text-indent: 0.5in;">In the
afternoon, we had the opportunity to examine the water cisterns with the new
chlorination systems in La Hicaca and Chorro Viento. We drove to La Culatta and
climbed up to Chorro Viento. The 45-minute hike was definitely not an easy one
and made me appreciate the 5-6 hour journeys many people endure to come to the
brigade. Below are some pictures of the cisterns and the chlorination system
installed.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWc3453egheMFtgxcXSeatCiPY2RHrvix8zYCW_hp6YNNeBzCLTbjKl4GlZhncXA5gcq1fb1zD5xrc-v0zzdYyul1Np5xolDlNHbTEq7vK6bb89iZ9ey51sD_ESaz0iVESntvHa5Um3Y5N/s1600/pic6.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWc3453egheMFtgxcXSeatCiPY2RHrvix8zYCW_hp6YNNeBzCLTbjKl4GlZhncXA5gcq1fb1zD5xrc-v0zzdYyul1Np5xolDlNHbTEq7vK6bb89iZ9ey51sD_ESaz0iVESntvHa5Um3Y5N/s1600/pic6.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">New chlorination system in Chorro Viento</td></tr>
</tbody></table>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRjK3ChuUOyQ7CQPevgV438YzWlyru4B12Kq0tR68HBfqFoANuOTtHc6qGc6QRXTxI180ydPr1ew6ryYHsrjSOyTmeS1AcW7HmdH7YKnxijZDc2vV8cblLkDAaE55EYOmMGIn-gH-LZrCl/s1600/pic5.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRjK3ChuUOyQ7CQPevgV438YzWlyru4B12Kq0tR68HBfqFoANuOTtHc6qGc6QRXTxI180ydPr1ew6ryYHsrjSOyTmeS1AcW7HmdH7YKnxijZDc2vV8cblLkDAaE55EYOmMGIn-gH-LZrCl/s1600/pic5.jpg" height="320" width="240" /></a><br />
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<span style="font-family: Cambria, serif; text-indent: 0.5in;">We attended
Mass on Friday evening, traveled back to San Pedro Sula Saturday morning, and
flew back to the US on Sunday. Although a short trip, we have gained a
substantial amount of knowledge on current programs implemented in La Hicaca
and surrounding villages.</span></div>
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<span style="font-family: Cambria, serif; text-indent: 0.5in;">I cannot
wait to return in June- to see the progress and of course, to see my friends.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh_biQJPmYxRvgWJN3G7ITaO_m9oYXu8UQKRKTL8UjxXaa_SC5uvwFxjWHt7OpIcAf6d8fN4RmFkvabLMLwWamy6HbD0Q6N7Smf1l3P_xMh4Pr5O5nvyNshx0lWphtdWVk1wpSOqhqTwPw/s1600/pic7.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh_biQJPmYxRvgWJN3G7ITaO_m9oYXu8UQKRKTL8UjxXaa_SC5uvwFxjWHt7OpIcAf6d8fN4RmFkvabLMLwWamy6HbD0Q6N7Smf1l3P_xMh4Pr5O5nvyNshx0lWphtdWVk1wpSOqhqTwPw/s1600/pic7.jpg" height="320" style="cursor: move;" width="240" /></a></div>
<!-- Blogger automated replacement: "https://images-blogger-opensocial.googleusercontent.com/gadgets/proxy?url=http%3A%2F%2F1.bp.blogspot.com%2F-JP0TqKawvpQ%2FVPii-StFc0I%2FAAAAAAAABiw%2F26QyJD0LF6o%2Fs1600%2Fpic4.jpg&container=blogger&gadget=a&rewriteMime=image%2F*" with "https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggVVs84M7fXK87qaQ2yNV6jVtrJ63gRfp_PhGNfgQpuGm5Lj3VovU19YFuAfy49f19qnBKIod7_hRul_3I4u9mGTqjjAZVFoBnONd5OKIlacKubBPS7gMj4Ji_tNGbF45RVnS_fgTokFLK/s1600/pic4.jpg" -->Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-43271863809977889342015-02-16T08:57:00.002-08:002015-02-16T09:01:35.703-08:002015 GH2DP-Engineers Without Borders Collaboration <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY1c3wk5jVIFr4nAKBWhkcuYWxRQo6WNptEuLfIk8a2aiIDwZVHoGjkW3sX7NLaG6ddmhyphenhyphenjPDf4TVZZ0GOcLLGsuxsZkXcOr-CIaDo9hap5htdTIPH4C_HNd5dhx_chZhTMGAtpX_C9W_A/s1600/IMG_5844.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiY1c3wk5jVIFr4nAKBWhkcuYWxRQo6WNptEuLfIk8a2aiIDwZVHoGjkW3sX7NLaG6ddmhyphenhyphenjPDf4TVZZ0GOcLLGsuxsZkXcOr-CIaDo9hap5htdTIPH4C_HNd5dhx_chZhTMGAtpX_C9W_A/s1600/IMG_5844.jpg" height="320" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="text-align: center;">
VCU EWB students working with a </div>
<div style="text-align: center;">
<span style="font-size: 12.8000001907349px;">biosand filter prototype </span></div>
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</tbody></table>
We are very excited to be collaborating again with <a href="http://www.studentorg.vcu.edu/soewb-vcu/" target="_blank">VCU's Engineers Without Borders (EWB)</a> chapter for our upcoming outreach trip in June.<br />
<br />
This year there are plans on trialing a new biosand filter that may ultimately provide clean drinking water to people in very remote regions of Honduras. The EWB group has created a prototype device and has plans to systematically study this over the next few months and on the ground in Honduras this upcoming June. The group also will <a href="http://mpstevens.blogspot.com/2014/04/vcu-honduras-outreach-projects.html" target="_blank">re-trial a novel water catchment device</a> first deployed in Honduras in June 2014.<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiedBtQUsVv3V14-R7cpv2WtbUykGKPjHeF1eOzum7plkXRvjS7Hedo5yZ6FeZv3blNpuvR02OC4MUAR3T9gTUHWaJRpkqT-lwQoL4s2H_WeKKzCmXatMGWZSCHvdP40Jewx18vp-gby0My/s1600/2014,+6+%5BJune+1-10%5D-Honduras-Folder+1_350.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiedBtQUsVv3V14-R7cpv2WtbUykGKPjHeF1eOzum7plkXRvjS7Hedo5yZ6FeZv3blNpuvR02OC4MUAR3T9gTUHWaJRpkqT-lwQoL4s2H_WeKKzCmXatMGWZSCHvdP40Jewx18vp-gby0My/s1600/2014,+6+%5BJune+1-10%5D-Honduras-Folder+1_350.jpg" height="213" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">EWB students Lucas Potter and Kristina Kelly deploying a<br />
novel water catchment device in La Hicaca, Honduras, June 2014</td></tr>
</tbody></table>
<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-58826566359203655882014-11-07T11:05:00.001-08:002014-11-07T11:07:16.659-08:00Ebola Outbreak Update: Updated WHO Information through November 4th <div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhauAE5pkCpgKai4TnH8JWv6gcWAjq5GbJtYykL22qnr5HoS6QluOuQhllW-XmBm8kzWkNpG6CBZWF3gdjFOD8tylXCkW28t3lRp5eT0jc8wEBsFSr_8-Z3-aWGZuE51e2UwTM4Jt6bGr6o/s1600/Screen+Shot+2014-11-07+at+1.56.36+PM.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhauAE5pkCpgKai4TnH8JWv6gcWAjq5GbJtYykL22qnr5HoS6QluOuQhllW-XmBm8kzWkNpG6CBZWF3gdjFOD8tylXCkW28t3lRp5eT0jc8wEBsFSr_8-Z3-aWGZuE51e2UwTM4Jt6bGr6o/s1600/Screen+Shot+2014-11-07+at+1.56.36+PM.png" height="193" width="320" /></a></div>
<br />
The <a href="http://apps.who.int/iris/bitstream/10665/137592/1/roadmapsitrep_7Nov2014_eng.pdf?ua=1" target="_blank">WHO</a> has released <a href="http://apps.who.int/iris/bitstream/10665/137592/1/roadmapsitrep_7Nov2014_eng.pdf?ua=1" target="_blank">updated information</a> regarding the current outbreak of Ebola.<br />
<br />
As of November 4th there have been 13,268 cases with 4,960 deaths.<br />
<br />
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.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-71G52vOj5NlxCu2zVtG2pl4-QI7W3W9ZR2knBgw-SWWMJyKQ8pW0R5UQBAdaEMW_GtMkgYtEwOArCKc_bXdXwXTYvw-cNdfpiER2XVR6km-rV9-O6sj3gqmiPS2Od3V4xP-wriwB7W2z/s1600/Screen+Shot+2014-11-07+at+1.56.03+PM.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-71G52vOj5NlxCu2zVtG2pl4-QI7W3W9ZR2knBgw-SWWMJyKQ8pW0R5UQBAdaEMW_GtMkgYtEwOArCKc_bXdXwXTYvw-cNdfpiER2XVR6km-rV9-O6sj3gqmiPS2Od3V4xP-wriwB7W2z/s1600/Screen+Shot+2014-11-07+at+1.56.03+PM.png" height="128" width="320" /></a>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).<br />
<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-13581266117357238122014-11-06T08:06:00.002-08:002014-11-07T10:42:56.235-08:00Congratulations to our GH2DP Student and Resident Researchers!<div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7NpPJS0e8zdrvyfLXflciu65x7NKDPLb5yo9zsL2Dau_Rh-i6QwYx03zORDJnLYydM4PG7Z4VH_XvLjNOCf9yq7WHbj9diyCbX6LePOojM5vtDnppo5cVvwAILjX3gu_c4WwN1AG4tOp4/s1600/Nehal+at+ASTMH_2014.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7NpPJS0e8zdrvyfLXflciu65x7NKDPLb5yo9zsL2Dau_Rh-i6QwYx03zORDJnLYydM4PG7Z4VH_XvLjNOCf9yq7WHbj9diyCbX6LePOojM5vtDnppo5cVvwAILjX3gu_c4WwN1AG4tOp4/s1600/Nehal+at+ASTMH_2014.jpg" height="320" width="180" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">GH2DP Student Scholar Nehal Naik<br />
in New Orleans</td></tr>
</tbody></table>
Congratulations to our <a href="http://www.gh2dp.vcu.edu/Home.html" target="_blank">GH2DP</a> student and resident researchers who presented their research projects this week at the <a href="http://www.astmh.org/Home.htm" target="_blank">American Society of </a><br />
<a href="http://www.astmh.org/Home.htm" target="_blank">Tropical Medicine & Hygiene's annual meeting in New Orleans</a>. </div>
<div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_IF0l3MzM_t0td-9KQLKSKhUSGv-GB8bUI6pS0MetLEl_NLT2axR14uk9Ycws9MOvx6_YZsRyKlusePP69ABuv8K3ip6Kzooq3lcKwDd69OwtEP8d2uHW9SXq7mZJ3wBjoUKYh2Ml33tp/s1600/RAMA+at+ASTMH_2014.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_IF0l3MzM_t0td-9KQLKSKhUSGv-GB8bUI6pS0MetLEl_NLT2axR14uk9Ycws9MOvx6_YZsRyKlusePP69ABuv8K3ip6Kzooq3lcKwDd69OwtEP8d2uHW9SXq7mZJ3wBjoUKYh2Ml33tp/s1600/RAMA+at+ASTMH_2014.jpg" height="320" width="180" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">GH2DP Pathway Resident<br />
Dr. El-Yafawi in New Orleans</td></tr>
</tbody></table>
<br /></div>
<div>
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 <a href="https://vcu.collegiatelink.net/organization/engineerswithoutbordersvcu" target="_blank">Engineers Without Borders</a>. </div>
<div>
<br /></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1AUqQKo9rS18o0U1g2x9hFICuN2rJVpWl6IODqe11yhJPTCi98vPWKTkhGzabeYc606DODI7ND8bCv_VNkIqv-GzbItZ5WIbJCG0k1j3LnA03u41sqTY4iSC2UYKooBQBLF_Q85OJEQAz/s1600/Pryor_ASTMH_2014.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1AUqQKo9rS18o0U1g2x9hFICuN2rJVpWl6IODqe11yhJPTCi98vPWKTkhGzabeYc606DODI7ND8bCv_VNkIqv-GzbItZ5WIbJCG0k1j3LnA03u41sqTY4iSC2UYKooBQBLF_Q85OJEQAz/s1600/Pryor_ASTMH_2014.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">GH2DP Student Scholar Rachel Pryor</td></tr>
</tbody></table>
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. </div>
<div>
<br /></div>
<div>
Rachel Pryor, a <a href="http://www.gh2dp.vcu.edu/GH2DP_Student_Scholars_Program.html" target="_blank">GH2DP Student Scholar</a> and MPH candidate at VCU presented her data on knowledge about and access to cervical cancer screening in Yoro, Honduras. </div>
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Congratulations again to all of these terrific student and resident researchers!</div>
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Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-21631712712644646472014-10-31T09:00:00.001-07:002014-10-31T09:00:13.664-07:00WHO Ebola Update: 10/29/14<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmKk-sEuvTsXKY70e3m2QGlAkv05nC3Gc3paYuk9KF8e8XjouhxlsdTCxpqADYB-FAxz3jUoYUqvIyeawYMOI6PLeEiQ5IbEZwDPwdZW26CTrSFpxC4zlWKeMBrhIbDXeTcx-sw4iXKiHZ/s1600/WHO_Ebola+response+roadmap.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmKk-sEuvTsXKY70e3m2QGlAkv05nC3Gc3paYuk9KF8e8XjouhxlsdTCxpqADYB-FAxz3jUoYUqvIyeawYMOI6PLeEiQ5IbEZwDPwdZW26CTrSFpxC4zlWKeMBrhIbDXeTcx-sw4iXKiHZ/s1600/WHO_Ebola+response+roadmap.jpg" height="275" width="320" /></a></div>
The latest WHO Ebola update document has been posted and can be found <a href="http://apps.who.int/iris/bitstream/10665/137376/1/roadmapsitrep_29Oct2014_eng.pdf?ua=1" target="_blank">here</a>. 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.<br />
<br />
Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-25039532784379986212014-10-24T02:58:00.000-07:002014-10-24T02:58:33.835-07:00WHO: Updated Ebola Outbreak Information <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRez03CCUZVHtd9a6kWzDm4ZsXQFip5oP59ZDM5KSK5n6VtN_kNsabCCdrcqPsRiK7zwvpw4XCaBuV7mM95-eHZehuxEWtbgkwpcCWow8E3ZIddWAbH-PPKatd0Wcb2aR7PjZYDCl4oAkF/s1600/Screen+Shot+2014-10-24+at+5.51.42+AM.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRez03CCUZVHtd9a6kWzDm4ZsXQFip5oP59ZDM5KSK5n6VtN_kNsabCCdrcqPsRiK7zwvpw4XCaBuV7mM95-eHZehuxEWtbgkwpcCWow8E3ZIddWAbH-PPKatd0Wcb2aR7PjZYDCl4oAkF/s1600/Screen+Shot+2014-10-24+at+5.51.42+AM.png" height="320" width="294" /></a></div>
The latest WHO Ebola situation report can be found <a href="http://apps.who.int/iris/bitstream/10665/137091/1/roadmapsitrep22Oct2014_eng.pdf?ua=1" target="_blank">here</a>. Key points:<br />
<br />
1) As of 10/19 there have been 9,936 cases and 4,877 deaths<br />
2) The outbreak in Senegal was declared over on 10/17<br />
3) The outbreak in Nigeria was declared over on 10/19<br />
<br />
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.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg24tbZlLZ2ge7EEBPYT-QXaJRVA_Tid5RtGBydHBX3wstxzGJNEPdiEuKAsImujbh-FCa8SpJKzRBEVQK9KO5BcUN9gAaSCcthIw-cfyvj9e8_FNLBSE_woaXWOuYWoNlEW-JaN3R6Qy7H/s1600/Screen+Shot+2014-10-24+at+5.50.52+AM.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg24tbZlLZ2ge7EEBPYT-QXaJRVA_Tid5RtGBydHBX3wstxzGJNEPdiEuKAsImujbh-FCa8SpJKzRBEVQK9KO5BcUN9gAaSCcthIw-cfyvj9e8_FNLBSE_woaXWOuYWoNlEW-JaN3R6Qy7H/s1600/Screen+Shot+2014-10-24+at+5.50.52+AM.png" height="156" width="320" /></a></div>
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<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-4681043522936153932014-08-16T03:15:00.000-07:002014-08-16T03:15:11.542-07:00West Africa Ebola Outbreak: August 15th Update<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSHuGDAnfpaQ1IUUhBOLjHJaFntPmQ2IcN9DjLLU8Jzco2umHYyVpBAfIK11y6MycZVBdkcdWwZ-spT1FLWxPyZBFZuhq4gI5qMNyWKRZPFiULKngEgRXZS76qzl6WVwfnDL1TC0zn_eAu/s1600/Screen+Shot+2014-08-16+at+6.00.03+AM.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSHuGDAnfpaQ1IUUhBOLjHJaFntPmQ2IcN9DjLLU8Jzco2umHYyVpBAfIK11y6MycZVBdkcdWwZ-spT1FLWxPyZBFZuhq4gI5qMNyWKRZPFiULKngEgRXZS76qzl6WVwfnDL1TC0zn_eAu/s1600/Screen+Shot+2014-08-16+at+6.00.03+AM.png" height="320" width="239" /></a>The WHO has released <a href="http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html" target="_blank">updated </a>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.<br />
<br />
Cases are being reported in Guinea, Sierra Leone, Liberia and Nigeria.<br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo2MmDhCT86f0xk9MJ27WwGkHNLBqU8X5u85qJWWaAwaWsojpg37zYR38xggfdb2LdRn9wFA5tfRH3Kg2g6fd0HROCpZQZKf3JK2SgZ1MM8vNolX5y5r3_4cayTrznoj6XAInrjYzDtsa3/s1600/Screen+Shot+2014-08-16+at+6.03.33+AM.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo2MmDhCT86f0xk9MJ27WwGkHNLBqU8X5u85qJWWaAwaWsojpg37zYR38xggfdb2LdRn9wFA5tfRH3Kg2g6fd0HROCpZQZKf3JK2SgZ1MM8vNolX5y5r3_4cayTrznoj6XAInrjYzDtsa3/s1600/Screen+Shot+2014-08-16+at+6.03.33+AM.png" height="320" width="240" /></a>The CDC has a lot of very nice, targeted health information about Ebola: see <a href="http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html" target="_blank">here</a>. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_OippofLanLns90b_snp_TMdvkehKQqkOdb38LPRKQhDx-8_sLW87FKFyBEnSaARRNLG4hFIcee5q8aI5hwi4Hkd6D0TgEBJp-4KQQC893jdMc8TQ7o0KYWxNv3jUyzUffVcbcPMxbqJI/s1600/Screen+Shot+2014-08-16+at+6.00.18+AM.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_OippofLanLns90b_snp_TMdvkehKQqkOdb38LPRKQhDx-8_sLW87FKFyBEnSaARRNLG4hFIcee5q8aI5hwi4Hkd6D0TgEBJp-4KQQC893jdMc8TQ7o0KYWxNv3jUyzUffVcbcPMxbqJI/s1600/Screen+Shot+2014-08-16+at+6.00.18+AM.png" height="320" width="276" /></a></div>
Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0tag:blogger.com,1999:blog-3059321477138638966.post-48466214455140404032014-08-04T10:08:00.001-07:002014-08-04T10:08:14.529-07:00Ebola Outbreak Update: July 31-August 1 <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgc_PRh2NnzjD9n9UAE5KOWjWdbJAavsBuwpzcq7tp7KfR_VeMVPk03rkYUHFk1K3sATE8nq4qaxRYtSXEZNB9SMTbAuay-ZNH760uYudomYOw1z0Lt_OMWFfVLOrGOpMjxODCIl6haJ-jA/s1600/EBOLA_OUTBREAK_CDC.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgc_PRh2NnzjD9n9UAE5KOWjWdbJAavsBuwpzcq7tp7KfR_VeMVPk03rkYUHFk1K3sATE8nq4qaxRYtSXEZNB9SMTbAuay-ZNH760uYudomYOw1z0Lt_OMWFfVLOrGOpMjxODCIl6haJ-jA/s1600/EBOLA_OUTBREAK_CDC.jpg" height="139" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">cdc.gov</td></tr>
</tbody></table>
The <a href="http://www.who.int/csr/don/2014_08_04_ebola/en/" target="_blank">World Health Organization</a> has posted <a href="http://www.who.int/csr/don/2014_08_04_ebola/en/" target="_blank">updated information on the Ebola outbreak in West Africa</a>.<br />
<br />
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.<br />
<br />
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<a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1404505" target="_blank"> recent report</a> in the <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1404505" target="_blank">New England Journal of Medicine</a>).<br />
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1h9qHNtmRWCfvP5vIkf_iDJB93scIIfRxcjTmuAPBYFWXpc7I2b0rv8U65bPdA8JIpdsnZ-tQi8JxPi9u1GUiUuj6oaKxJVCla2zXBkh0J6uNoK4Tx6iu9jM70M_wUT14ZZRZbxEulk0x/s1600/Ebola.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1h9qHNtmRWCfvP5vIkf_iDJB93scIIfRxcjTmuAPBYFWXpc7I2b0rv8U65bPdA8JIpdsnZ-tQi8JxPi9u1GUiUuj6oaKxJVCla2zXBkh0J6uNoK4Tx6iu9jM70M_wUT14ZZRZbxEulk0x/s1600/Ebola.jpg" height="240" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Total Ebola Cases/ Deaths Per Country to Date</td></tr>
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As noted recently by CDC director Dr. Thomas Frieden<a href="http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-outbreak-not-cards-u-s-cdc-director-says-n169836" target="_blank"> "Ebola poses little risk to the U.S. general population."</a> 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.<br />
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One of the factors that promoted the expansion of the current outbreak was the long time it took for the outbreak to be recognized. <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1404505" target="_blank">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</a>. 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.<br />
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<br />Mike Stevens, MD, MPHhttp://www.blogger.com/profile/05455818902032108245noreply@blogger.com0