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CDC, In the News, Infectious Disease, Neuroscience, Pediatrics

Stanford experts offer more information about enterovirus-D68

Stanford experts offer more information about enterovirus-D68

Below is an updated version of an entry that was originally posted on Sept. 26.

SONY DSCLast week, the California Department of Public Health confirmed that the season’s first four cases of enterovirus-D68 respiratory illness had been found in the state, three in San Diego County and one in Ventura County, with more expected to surface. As of Sept. 29, this makes California one of 40 states across the nation to be affected by EV-D68.

Health officials in Colorado are now investigating a handful of cases of paralysis in children there; the paralysis began a few weeks after respiratory illness and appears to be connected to EV-D68. Since the same virus was tentatively linked to paralysis cases in California children earlier this year, California officials are monitoring the situation closely.

Below, Yvonne Maldonado, MD, service chief of pediatric infectious disease at Lucile Packard Children’s Hospital Stanford, answers additional questions about the respiratory symptoms caused by this virus. Keith Van Haren, MD, a pediatric neurologist who has been assisting closely with the California Department of Public Health’s investigation, also comments on neurologic symptoms that might be associated with the virus.

Enteroviruses are not unusual. Why is there so much focus from health officials on this one, EV-D68?

Maldonado: The good news is that this virus comes from a very common family of viruses that cause most fever-producing illnesses in childhood. But it’s been more severe than other enteroviruses. Some hospitals in other parts of the country have had hundreds of children coming to their emergency departments with really bad respiratory symptoms. The fact that it’s been so highly symptomatic and that there has been a large volume of cases is why it has gotten so much attention.

Van Haren: It’s important to remember that most children and adults who are exposed to enteroviruses don’t get sick at all. A smaller percentage come down with fever and/or respiratory symptoms, as Dr. Maldonado has described. And as far as we can tell, it’s only a very, very small number of children, if any, who get paralysis, typically affecting one arm or leg. The Centers for Disease Control and the California Department of Public Health are still investigating to try to determine conclusively whether EV-D68 is causing neurologic symptoms, such as paralysis.

What do we know about the course of possible neurologic symptoms of EV-D68 and their potential treatments?

Van Haren: We’re still learning about the possible neurologic symptoms and how we might treat them. To start, we have a growing suspicion that EV-D68 may be associated with paralysis. In the patients we’ve seen with paralysis, progression of weakness appears to stop on its own, and recovery of strength is very slow and usually incomplete.

Which groups are most at risk?

Maldonado: Children with a history of asthma have been reported to have especially bad respiratory symptoms with this virus. It can affect kids of all ages, from infants to teens. So far, only one case has been reported in an adult, which makes sense because adults are more likely to have immunity to enteroviruses. We do worry more about young infants than older children, just because they probably haven’t seen the virus before and can get worse respiratory symptoms with these viral infections.

Van Haren: We don’t yet know who is most at risk for paralysis or other neurologic symptoms, but we are studying this carefully to find out why some children get sick and some do not. So far, it seems that the children who have been affected by paralysis were generally healthy prior to their illness.

What is the treatment for EV-D68?

Maldonado: There is no treatment that is specific to the virus. At home, parents can manage children’s fevers with over-the-counter medications, make sure they drink lots of fluids to avoid dehydration, and help them get plenty of rest. For children who are very ill, doctors will check for secondary illnesses such as bacterial pneumonia, which would be treated with antibiotics, and may hospitalize children who need oxygen or IV hydration to help them recover.

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Global Health, Infectious Disease, Patient Care, SMS Unplugged

The hand-sanitizer dilemma: My experiences treating patients in Uganda

The hand-sanitizer dilemma: My experiences treating patients in Uganda

Ugandan hospital - smallSMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A thick green glob landed on my scrub top at the same time that the first drop of sweat rolled down the small of my back. I tried not to grimace and discretely walked over to the hand-sanitizer dispenser. But like every other hand sanitizer I had tried, this one was empty. Yesterday I had also discovered that the only bathroom in the hospital had no toilet paper. It was 7 AM, and I would be using my pocket toilet-paper stash to clean off sputum from the hacking patient that apparently all the doctors knew to avoid standing in front of. The day was off to a good start.

How, I wondered as we continued rounding, did doctors respond to this dilemma – having to care for patients without being able to fully protect themselves – when they were in health centers treating Ebola. I tried not to think about what I would tell my parents if I developed rare infectious symptoms in a few days. We were in Uganda, countries away from the Ebola outbreak, but there were still plenty of infectious agents we could and probably were exposing ourselves to.

Just as I was wracking my brain for the names of the bacteria and viruses that might be deadly, I noticed one of the doctors rest his hand on a patient’s shoulder. And it dawned on me that the real dilemma was not about what I, who had access to the best medical care, might pick up, but rather about what I might pass from patient to patient.

It’s ironic that in the U.S., patients have to remind doctors to reach out and touch their shoulder or hand at an appropriate time – to make patients feel that the doctor connects with them on a human level. Yet here in Uganda, the  doctors know when to reach out to their patients, they know how to talk to the patient’s family. My clinical-skills professors would love to see this.

But if the hand-sanitizer dispenser was empty for me, it was empty for the  Ugandan doctors as well. We were told as first-year medical students that we would fail our “Practice of Medicine” final if we forgot to sanitize our  hands upon entering our standardized patient’s room. So what were we to do when we had more than twenty patients in one room, each with at least two family members, and no hand sanitizer for anyone? How many of these dozens  of people were walking around with my hacking patient’s sputum on them as  well?

The doctors certainly could be spreading infectious agents. But given the proximity of patients on the wards, those very same infectious agents had likely already been spread between the patients overnight – before we even arrived that morning. I couldn’t help but wonder which was more important to the patients who had a 50 percent chance of survival: to feel that their doctor was treating them as a human being or to increase their chance of survival by a negligible margin? How big or small would the margin introduced by the doctor’s touch have to be to tip the scale one way or another?

Before I could finish thinking through my ethical dilemma, we left the ward to scrub in for surgery. There I found the only working hand-sanitizer dispenser.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo of Ugandan hospital by Natalia Birgisson

Clinical Trials, History, Immunology, Infectious Disease, Research

Stanford scientists strive to solve centuries-old puzzle: Why are young children so vulnerable to disease?

Stanford scientists strive to solve centuries-old puzzle: Why are young children so vulnerable to disease?

512px-Gabriël_Metsu_-_The_Sick_Child_-_WGA15091

Several months ago, Stanford immunologist Mark Davis, PhD, went for a stroll in Union Cemetery in Redwood City, Calif. (not far from the Stanford campus). Graves there date from the Civil War-era and Davis, who’s currently immersed in a study of childhood immunity, was intrigued.

“In the early years, you see entire families — mom, dad, and then a whole bunch of children’s headstones,” Davis told me. “It really brought home to me how differently we live now that we just take for granted a kid will survive and grow up.”

Vaccines arrived and childhood survival rates soared. Yet young children remain much more vulnerable to infectious diseases than adults. Why?

Davis and his team think vaccines trigger a set of changes that strengthens children’s immune systems — allowing them to ward off diseases they haven’t even heard of before. That’s why the researchers are conducting a group of studies, all focused on revealing new details about the immune system’s response to the flu vaccine. They need participants, particularly young children who have never received a flu vaccine before. They also need older children and twins. All participants will receive a licensed flu vaccine that will help protect from influenza this coming winter.

Davis and colleagues plan to investigate the children’s development of two types of immune cells — memory T and B cells — that are specialized to recognize certain foreign invaders. Interestingly, adults have T cells that spot diseases they’ve never been exposed to, such as HIV, Davis said. Yet newborns lack these specialized cells, leaving them vulnerable to infection.

“Somewhere between birth and adulthood we see the appearance of these memory T cells without having the particular disease,” Davis said. “It’s a real puzzle.”

Davis suspects that routine vaccines and infections may spur the development in children of a broad spectrum of memory T cells, ones that recognize all sorts of diseases. One study plans to follow children for several years, perhaps revealing how, and when, the children develop a full compliment of these memory T cells, Davis told me.

The studies are possible thanks to the development of new analytical techniques, according to virologist and immunologist Harry Greenberg, MD, who is working with Davis on the influenza studies.

“We’ve been studying influenza for half a century, but these new assays developed in the last five years offer hope we can develop better ways of protecting more people,” Greenberg told me.

More information about the flu vaccine studies and the Stanford-LPCH Vaccine Program is available here or (650) 498-7284.

Becky Bach is a proud graduate of the UC Santa Cruz Science Communication Program (go Banana Slugs!) and a science-writing intern at the Office of Communications and Public Affairs.

Previously: Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert, Gut bacteria may influence effectiveness of flu vaccine and Side effects of childhood vaccines are extremely rare, new study finds
Photo by Gabriel Metsu

CDC, In the News, Infectious Disease, Pediatrics, Public Health

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

SONY DSCToday’s New York Times features a story on the accelerating spread of enterovirus-D68, a virus that is causing severe respiratory illness in children across the country. As the Times reports, some emergency departments in the Midwest have been so swamped with cases that they’ve had to divert ambulances to other hospitals. Although California is still only lightly affected, the state’s first four cases were confirmed by the California Department of Public Health late last week, with more expected to surface.

To help parents who may be wondering how to prevent, spot and care for EV-D68 infection, Yvonne Maldonado, MD, service chief of pediatric infectious disease at Lucile Packard Children’s Hospital Stanford, answered some common questions about the virus:

Enteroviruses are not unusual. Why is there so much focus from health officials on this one, EV-D68?

The good news is that this virus comes from a very common family of viruses that cause most fever-producing illnesses in childhood. But it’s been more severe than other enteroviruses. Some hospitals in other parts of the country have had hundreds of children coming to their emergency departments with really bad respiratory symptoms. The fact that it’s been so highly symptomatic and that there has been a large volume of cases is why it has gotten so much attention.

Have any patients at Lucile Packard Children’s Hospital Stanford been affected with EV-D68?

As of today (Sept. 26), we have not yet had a documented case at our hospital. However, there have been a total of 226 confirmed cases in 38 states across the country. Some children who have this virus are probably not being tested, so the real number of cases nationwide is likely to be higher.

If your child has respiratory symptoms and you suspect EV-D68, what should you do?

The virus causes symptoms such as coughing, sneezing and runny nose. In some cases but not all, kids also have a fever. If your child has respiratory symptoms with or without a fever, especially if he or she also has a history of asthma, monitor your child at home. If you feel that he or she has been sick for a long period, is getting worse or is experiencing worsening of asthma or difficulty breathing, go see your pediatrician.

Which groups are most at risk?

Children with a history of asthma have been reported to have especially bad respiratory symptoms with this virus. It can affect kids of all ages, from infants to teens. So far, only one case has been reported in an adult, which makes sense because adults are more likely to have immunity to enteroviruses. We do worry more about young infants than older children, just because they probably haven’t seen the virus before and can get sicker with these viral infections.

How can the illness be prevented?

This virus is spread by contact with secretions such as saliva. If your children are sick, they should stay home from school to avoid spreading the illness to others. To avoid getting sick, stay at least three feet from people with symptoms such as coughing and runny nose, wash your hands frequently, and make sure your kids wash their hands often, too.

What is the treatment for EV-D68?

There is no treatment that is specific to the virus. At home, parents can manage children’s fevers with over-the-counter medications, make sure they drink lots of fluids to avoid dehydration, and help them get plenty of rest. For children who are very ill, doctors will check for secondary illnesses such as bacterial pneumonia, which would be treated with antibiotics, and may hospitalize children who need oxygen or IV hydration to help them recover.

Previously: Tips from a child on managing asthma
Photo by Michelle Brandt

Cancer, Global Health, Health Policy, Infectious Disease, Public Health

Treating an infection to prevent a cancer: H. pylori and stomach cancer

Treating an infection to prevent a cancer: H. pylori and stomach cancer

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The number of newly diagnosed stomach cancer cases in the United States is less than a tenth of the number of prostate cancer cases or breast cancer cases, which may be part of the reason it doesn’t get the same attention as breast and prostate cancer. But the mortality rate is much higher for stomach (or gastric) cancer. Nearly 11,000 Americans will likely die from gastric cancer this year, with only 28 percent of cases surviving five years or more. For comparison, the five-year survival rate for prostate cancer is nearly 99 percent and for breast cancer, it’s more than 89 percent.

On a global scale, an estimated 700,000 people will die from gastric cancer this year, as Stanford infectious disease specialist Julie Parsonnet, MD, and her co-authors note in a Viewpoint piece in the most recent issue of the Journal of the American Medical Association. The authors also point out that worldwide, about 77 percent of gastric cancer cases are linked to chronic infections of Helicobacter pylori, a helix-shaped bacteria that was identified in the early 1980s and found to be linked to gastric ulcers a few years later, as well as to gastritis, an inflammation of the stomach lining that is a precursor to stomach cancer.

Researchers are still trying to understand exactly how H. pylori causes cancer or even how it colonizes the gastrointestinal track – they believe it’s picked up via food or water. Until recently, there was a dearth of randomized clinical trials that looked at the effectiveness of screening and treatment for H. pylori as a method for preventing stomach cancer.

Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy

In the opinion piece, the authors describe the recommendations of a working group that met in December 2013 at the behest of the International Agency for Research on Cancer. Taking the burden of the disease and the availability of treatment options in consideration, the group considered gastric cancer “a logical target for intervention,” according to the authors of the JAMA piece. They go on to write:

Screening and treatment for H pylori is generally acceptable and affordable. An inexpensive serological test can determine who may be infected, with a sensitivity and specificity that could be sufficient for population-based prevention programs. Low-cost treatment regimens using 2 or 3 generic antibiotics plus a proton pump inhibitor for 7 to 14 days can eradicate the infection in more than 80% of cases, depending on the antibiotic resistance patterns of H pylori within the population. Economic modeling studies indicate that H pylori screening and treatment strategies are cost-effective under a large range of assumptions about effectiveness and costs. However, the models are limited by reliance on observational data rather than randomized trial results, by a lack of information on possible adverse effects of treatment, and by limited data from lower-income countries.

Researchers still have many gaps in their understanding of the best methods to prevent stomach cancer, but several trials may answer some of those questions in the coming decade.

Stomach cancer is not the only cancer known to be linked with an infection. Doctors routinely test whether women who come in for a PAP smear are infected with the human papilloma virus (HPV), which is linked to cervical cancer. Chronic hepatitis B and C infections are known to be linked to liver cancer. In time, screening for H. pylori to prevent stomach cancer may become routine. Until then, Parsonnet and her coauthors say in their conclusion, “Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy.”

Previously: Researchers identify potential drug target in ulcer bug that infects half the world’s population, Good-bye cancer, good-bye stomach: A survivor shares her tale and Image of the Week: Helicobacter pylori colonizing the stomach
Photo by Shuman Tan and Lydia-Marie Joubert

CDC, Events, Global Health, In the News, Infectious Disease

Ebola panel says 1.4 million cases possible, building trust key to containment

Ebola panel says 1.4 million cases possible, building trust key to containment

ebola workers2The Ebola epidemic is spreading rapidly – leaving a wake of suffering – in large part because West Africa has shockingly few medical facilities or trained personnel. But it’s exploding exponentially because of mistrust, a panel of experts told a packed crowd on the Stanford campus last evening.

The numbers, as described by Ruthann Richter in a just-published story, are sobering:

Officially, more than 5,800 Ebola cases and 2,800 deaths from the disease have been reported in four countries: Liberia, Guinea, Sierra Leone and Nigeria. But panelists said those figures were vastly underestimated. At the current rate of spread, in which the number of new infections is doubling every three weeks, the U.S. Centers for Disease Control and Prevention estimates that 1.4 million people could be infected by the end of January 2015 in the absence of dramatic interventions, said Douglas Owens, MD, a professor of medicine and director of the Center for Health Policy at Freeman Spogli Institute of International Studies.

But even with “very aggressive” intervention, Owens said, it’s estimated there would be at least 25,000 cases by late December. If intervention is delayed by just one month, there will be 3,000 new cases every day; if it’s delayed by two months, there will be 10,000 new cases daily, he said. “It gives you a sense of the extraordinary urgency in terms of time,” Owens told the audience.

During the talk Stanford health-policy expert Paul Wise, MD, screened a CNN video that depicts a man escaping from a treatment facility in Liberia. “You have to create treatment centers that are of the highest quality and that treat people with dignity — so people will want to go there, rather than escape,” he said.

Building trust starts local, Tara Perti, MD, told the audience. She works as a CDC epidemic intelligence service officer and spent time in both Guinea and Sierra Leone this summer:

In Guinea, she traveled to a village north of the capital city of Conakry, where she met two young men who had recovered from the disease, which has a fatality rate as high as 70 percent. One of the men had lost five members of his family, but he had become a community advocate. He traveled with Perti to a neighboring village, where they met a woman who was sick and whose son had died of the disease. “She was very fearful of going to the treatment center… but she was ultimately convinced to seek treatment. She recovered and was able to return home,” Perti said.

“The patient who survived was tremendously helpful because he could speak from experience and be credible. There needs to be more of these. In the forested region of Guinea, there are a lot of superstitions and different beliefs besides germ theory, and so it’s very challenging to go into those areas and help people understand that Ebola is a virus, it’s real and we do have ways to help patients.”

The world’s disjointed response to the epidemic points points to the need for global-health reforms, Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health, concluded.

Becky Bach is a former park ranger and newspaper reporter who now writes about science as an intern at the Office of Communications and Public Affairs. 

Previously: Interdisciplinary campus panel to examine Ebola outbreak from all angles, Expert panel discusses challenges of controlling Ebola in West Africa, Should we worry? Stanford’s global health chief weighs in on Ebola and Biosecurity experts discuss Ebola and related public health concerns and policy implications
Photo, of health workers at an Ebola treatment unit in Liberia, by USAID/Morgana Wingard

Ask Stanford Med, In the News, Infectious Disease, Public Health, Stanford News

A conversation on West Nile virus and its recent California surge

A conversation on West Nile virus and its recent California surge

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Ebola isn’t the only virus commanding media attention: West Nile virus, now in its 15th year in the United States, may be surging to unprecedented levels in California, fueled in part by the state’s earth-parching drought.

It’s a big deal elsewhere as well, with parts of Texas, Louisiana and Midwestern states like Nebraska are also being hit. But California – and its 237 cases as reported by the CDC –  has taken the lead, in part because the drought brings birds and mosquito together at the scarce sources of water, according to reports by the Wall Street Journal and San Francisco’s NPR-affiliate KQED. Some regions, including a few communities close to Stanford, are now spraying for the mosquitoes.

I recently chatted with infectious disease expert Lucy Tompkins, MD, PhD, about the disease and how to prevent it. (Tompkins, a fly fisherwoman, knows quite a bit about mosquitoes).

What are the symptoms of West Nile?

The majority of people who get bitten don’t have any symptoms. About 20 percent of those bitten develop what is called West Nile fever with a fever, aches, fatigue, maybe a headache and sometimes a rash. It was previously felt this was completely benign but there may be long-term effects. Less than one percent are  the serious  cases with involvement of the brain and nervous system, which has a high mortality rate. That’s particularly common in people who are immunosuppressed due to transplants or high use of prednisone or even to those over 50 years. It can be a very disabling infection.

What can people do to protect themselves?

Reduce standing water such as in bird baths and wear protective clothing with long sleeves, long pants and socks covering your pants. Use insect repellents containing DEET - not low-potency insecticides. If possible, avoid being out during the times of day mosquitoes are active such as early in the morning and at sunset. It’s all about prevention.

Why isn’t there a vaccine for West Nile?

The chances of any one person getting West Nile are pretty remote. There’s no market, honestly. There’s a much bigger demand in the veterinary market for a vaccine like this. There is a vaccine for horses – West Nile can be fatal in horses. It also affects dogs and cats. There are some experimental treatments – last year at Stanford we gave a patient an experimental treatment and he awoke from a coma.

Do you expect the virus to continue spreading?

It’s hard to predict from year to year what communities will be affected. It all depends on what happens in the environment. The best information is available at the CDC.

Becky Bach is a former park ranger who now spends her time writing about science or practicing yoga. She is a science-writing intern in the Office of Communications and Public Affairs.

Previously: Should local residents be worried about West Nile virus?, Image of the Week: West Nile virus and Close encounters: How we’re rubbing up against pathogen-packing pests
Photo by: CulexNil

Immunology, Infectious Disease, Pregnancy, Research, Women's Health

Study: Pregnancy causes surprising changes in how the immune system responds to the flu

Study: Pregnancy causes surprising changes in how the immune system responds to the flu

pregnant ladyWhen pregnant women get influenza, they tend to get really sick. Flu complications such as pneumonia are more common in pregnant women than other healthy young adults, and their risk of death from flu is higher, too.

Until now, doctors have ascribed the problem to the fact that the immune system is tamped down by pregnancy, a protective mechanism that keeps the woman’s body from rejecting her fetus. But a new Stanford study, the first ever to directly examine how a pregnant woman’s immune cells respond to flu viruses, found something unexpected: Instead of responding sluggishly, immune cells from pregnant women actually over-react to the flu. From our press release about the paper, which appears today in the Proceedings of the National Academy of Sciences:

“We were surprised by the overall finding,” said Catherine Blish, MD, PhD, assistant professor of infectious diseases and the study’s senior author. “We now understand that severe influenza in pregnancy is a hyperinflammatory disease rather than a state of immunodeficiency. This means that treatment of flu in pregnancy might have more to do with modulating the immune response than worrying about viral replication.”

In the lab, Blish’s team incubated immune cells obtained from pregnant and nonpregnant women’s blood samples with different strains of flu virus, including the H1N1 flu that caused the 2009 pandemic and also a less virulent strain of seasonal influenza. The responses they observed could help explain why flu, especially pandemic H1N1 flu, causes pneumonia in many pregnant patients:

Pregnancy enhanced the immune response to H1N1 of two types of white blood cells: natural killer and T cells. Compared with the same cells from nonpregnant women, H1N1 caused pregnant women’s NK and T cells to produce more cytokines and chemokines, molecules that help attract other immune cells to the site of an infection.

“If the chemokine levels are too high, that can bring in too many immune cells,” Blish said. “That’s a bad thing in a lung where you need air space.”

Why would influenza break the rules of how the immune system works in pregnancy? Blish thinks there’s a clue in the fact that the flu produces a fourfold increase in an expectant woman’s risk of delivering her baby prematurely. “I wonder if this is an inflammatory pathway that is normally activated later in pregnancy to prepare the body for birth, but that flu happens to overlap with the pathway and aberrantly activates it too early,” she said.

The research is a good reminder that flu season is just around the corner, and it’s time to start thinking about getting a flu shot, especially if you are pregnant or planning a pregnancy.

Previously: Text message reminders shown effective in boosting flu shot rates in pregnant women, Ask Stanford Med: Answers to your questions about seasonal influenza and Flu shots for moms may help prevent babies from being born too small
Photo by Meagan

Events, Global Health, Health Policy, In the News, Infectious Disease, Public Health

Interdisciplinary campus panel to examine Ebola outbreak from all angles

Interdisciplinary campus panel to examine Ebola outbreak from all angles

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Scientists have estimated that the West Africa Ebola epidemic will take another 12-18 months to control and will infect hundreds of thousands of more people during that time. In an opinion piece published last week in the Los Angeles Times, Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health, discussed how the outbreak got so out of control and explains why the “world needs a new approach to solving massive international health crises and preventing future ones.”

Tomorrow on the Stanford campus, Barry will participate in an interdisciplinary forum focusing on the health, governance, security and ethical dimensions of the epidemic. Additional speakers include Doug Owens, MD, a general internist and director of the Center for Health Policy/Primary Care Outcomes Research; microbiologist David Relman, MD, a fellow at the Center for International Security and Cooperation; Stephen Stedman, deputy director at the Center on Democracy, Development and the Rule of Law; and Paul Wise, MD, MPH, a child health specialist and core faculty member of the Center for Health Policy/Primary Care Outcomes Research. Drawing on their diverse backgrounds, the panelists will offer unique perspectives from their respective fields on the latest developments in addressing the outbreak.

The event will be held at 4 PM local time at the Bechtel Conference Center in Encina Hall and is free and open to the public. Conference organizers will also be live tweeting the panel; you can follow the coverage on the @FSIStanford Twitter feed, or by using the hashtag #EbolaForum.

Previously: Expert panel discusses challenges of controlling Ebola in West AfricaShould we worry? Stanford’s global health chief weighs in on Ebola, Biosecurity experts discuss Ebola and related public health concerns and policy implications and Stanford global health chief launches campaign to help contain Ebola outbreak in Liberia
Photo by European Commission DG ECHO

Global Health, In the News, Infectious Disease, Public Health

Expert panel discusses challenges of controlling Ebola in West Africa

The rapidly growing Ebola outbreak in West Africa is not only overwhelming the health systems of the countries involved, but the World Bank recently warned that it could trash the economies of Liberia, Guinea, and Sierra Leone – the countries that have seen the most cases. Since the first confirmed case in December 2013 in Guinea, almost 5,000 people have become infected with the virus in five countries and about half of them have died. On September 16, President Obama committed 3,000 military personnel to help fight the outbreak, along with other resources.

This morning, KQED’s Forum hosted a panel of Ebola experts, including Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health. The panel discussed some of the challenges this outbreak poses. One issue is the enormous need for resources to control an outbreak of this momentum and magnitude. The WHO estimates it will take about a billion dollars to contain and by some estimates, it will require 1,000 international health care workers to train national, local clinicians.

Barry discussed the prospects for Zmapp, an experimental drug to treat Ebola -“a cocktail of monoclonal antibodies” according to Barry – for helping to curb the disease. She said that besides the lack of human clinical data on the effectiveness of this drug, the difficulty producing the drug also slows down plans to use the medication in the field. She went on to say:

I do have optimism for containing the virus. What I don’t have optimism for is the long-term trajectory of the Liberian healthcare workforce. It’s been actually decimated. I think there are wonderful people there working on it on the ground, but actually, there’s only a only a couple hundred doctors and a serious percentage of them have died—as well as nurses, in this battle against Ebola.

She elaborated on her concerns for the long-term problems for controlling epidemics in general:

I think there are short-term problems, but then I would urge people to start – and I know many people are – to think about long term issues. The long term issues of when you have a WHO that’s had its budget decimated, and its pandemic and epidemic division disbanded. That needs to be strengthened. When you have a workforce in Africa of only – I mean they have 25 percent of the disease burden but only four percent of the workforce. That needs to be strengthened. So there are long term issues of control for future epidemics.

She also suggested that a global health worker reserve corps could be assembled, a fund to strengthen health systems could be established, much like The Global Fund to fight AIDS, Tuberculosis and Malaria, and the UN could take a more active role in large infectious disease epidemics.

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