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November 1, 2014

Posts in "Disease Control"

October 31, 2014

Economist: Economic Woes of Ebola in West Africa; Drug Manufacturers Expedite Work on Vaccines

The Ebola crisis is ravaging the economies of the Ebola stricken West African countries of Liberia, Sierra Leone and Guinea. The Economist magazine this week reports that the World Bank estimates the cost to the region at $33 billion over the next 18 months. Prices of food and some basic products have doubled but some commodity-based businesses have been able to continue to export products.

The Economist also reports on drug manufacturers redoubling efforts to produce an Ebola vaccine. The World Health Organization has partnered with GlaxoSmithKline and a U.S. firm, NewLink Genetics, to expedite work on a vaccine. The drugs will be ready for testing in Africa by the end of the year. Also, Johnson & Johnson announced announced last week that it will begin human trials in January on a separate vaccine.

 

Weekly Review: State Quarantine Battles Wait Out 21-Day Incubation Periods

The debate over travel restrictions on persons arriving from the Ebola ravaged region in West Africa shifted this week to posturing over the effectiveness and legality of varying state-level quarantine requirements. Last weekend’s imbroglio over initial strict quarantine rules in New York and New Jersey shifted to less stringent home-based quarantines and monitoring protocols in other states. The Centers for Disease Control and Prevention offered new monitoring guidelines, which helped states to minimize quarantine rules

A nurse, returning from assisting with West Africa relief efforts and originally interred in a New Jersey hospital, was released to travel to Maine. However, the dispute over the legality of Maine’s home-based quarantine has escalated into a current battle between the nurse and the state’s governor and health officials.

Anxiety over Ebola cases in the United States now festers as the current influx of returning volunteers wait out a 21-day waiting period for the possible incubation of the Ebola virus. Also, planning for possible new domestic Ebola cases is haunted by an Associated Press report that the U.S. health care system, especially smaller hospitals, are poorly prepared to handle even localized Ebola cases.

Meanwhile, Secretary of Defense Chuck Hagel this week finalized orders for a 21-day post-mission quarantine of returning military personnel currently serving in West Africa. The White House this week parried questions about the difference between an enforced quarantine for U.S. troops but not for returning civilian health care workers.

Congress is busy preparing for next week’s general election and the next congressional hearing on Ebola, originally scheduled for next week, was delayed until Nov. 12. Witnesses scheduled to testify are Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Disease Control and Prevention Director Tom Frieden. However, the newly appointed Ebola response czar, Ron Klain, is not currently slated to appear before the panel. Separately, various bipartisan pairs of lawmakers are plotting a legislative strategy to press for increased Ebola and other medical research funding.

 

 

October 29, 2014

Bipartisan Duos Identify Ways to Expedite Ebola Research Funding

When Congress returns next month, it really has one primary task – to extend the federal government’s ability to spend money. And lawmakers are already starting to talk about how Ebola might fit into that discussion.

The current short-term federal appropriations measure expires Dec. 11, and an extension will likely address the mechanics of funding for research on Ebola drugs. Bipartisan congressional leaders on Tuesday were calling for funding adjustments to speed Ebola drug development.

In the House, Michigan Republican Mike Rogers and California Democrat Anna G. Eshoo urged appropriators to include additional funding instructions in an HHS bio-defense program to expedite Ebola drug and vaccine research efforts.

In the Senate, the leaders of the Health, Education, Labor and Pensions Committee, Democrat Tom Harkin of Iowa and Republican Lamar Alexander of Tennessee, announced plans to introduce a bill that would allow funding for Ebola drug research through an existing FDA program designed to expedite the development of drugs to combat neglected tropical diseases. The senators note that Ebola is not currently listed as a qualifying drug for the program.

But discretionary spending limits and annual funding priority battles limit the expansion of medical research funding. CQ HealthBeat’s (CQHealthTweet) Kerry Young reports (subscription) that Utah Republican Sen. Orrin G. Hatch and Massachusetts Democratic Sen. Elizabeth Warren are circulating a separate draft bill intended to change that by marking off a permanent allocation of federal funding for biomedical research, separate from the contested pool of discretionary funds.

October 28, 2014

States Begin to Follow New CDC Guidance on Quarantines

The Centers for Disease Control and Prevention on Monday issued new guidelines on monitoring for the Ebola virus in travelers arriving from the Ebola infected region in West Africa. The new policy calls for home quarantines at the most restrictive level and ongoing monitoring for a 21-day period. The policy seeks to stem early attempts to enforce stricter state quarantines.

New York and New Jersey this weekend began implementing a hospital-based quarantine policy, which led to the CDC’s new less restrictive guidance on monitoring incoming persons potentially exposed to the virus. On Monday, New Jersey released its first quarantined patient and New York earlier updated its screening plan at JFK airport to include home monitoring. A range of states followed suit on Monday with updated guidelines that focus on home-based quarantines and activity restrictions. A sampling of states issuing updated guidelines include: Illinois, Maryland, Virginia, Georgia (assumes individual compliance), Minnesota and Maine.

October 27, 2014

Equating Ebola and the Flu on Capitol Hill

ebolasignphoto e1414346947759 240x321 Equating Ebola and the Flu on Capitol Hill

Sign at a deli on Capitol Hill, Sunday, October 26, 2014

CQ Roll Call staff today will be offered an annual flu shot. This year’s inoculation is especially pressing due to concerns about the Ebola virus, which have initial symptoms that are identical with the flu. The similarity of symptoms poses some possible confusion and increased anxiety as flu season begins. Reuters reported last week that hospitals fear a deluge of patients with the flu fearing they have Ebola.

This sign on Sunday greeted people walking by a popular Capitol Hill deli/grocery store. It seems the confusion has already begun.

 

 

 

 

This Week: Quarantine Wrangling

The focus this week, outside of preparations for next week’s congressional elections, will be on new state quarantine orders on health care workers returning from service in West Africa. On Friday, the governors of New York, New Jersey and Illinois initiated a mandatory quarantine targeting returning medical workers. This weekend Florida instituted a 21-day active monitoring regime for new arrivals. New York on Sunday adjusted the terms of the quarantine order, allowing persons under observation to be quarantined at home.

Separately today, the Centers for Disease Control and Prevention begins a previously announced revised post-arrival monitoring process for persons arriving from West Africa. A White House meeting on Sunday assembled a large group of federal officials ahead of possible new revisions to policies on monitoring incoming travelers.

Meanwhile this week, the Society for Women’s Health Research hosts a panel discussion on Wednesday at Washington, DC’s Union Station on expectations and experiences on breast cancer screening. Also on Wednesday, the Association of American Medical Colleges holds a teleconference on research on medical school application and enrollment data. On Thursday, the Cato Institute examines recent federal court rulings on the IRS’ interpretation of the 2010 health care overhaul law. The group is keen on garnering the court’s consideration of a challenge to the legality of federal insurance subsidies in states that utilize the federally operated insurance exchange.

The next congressional hearing on Ebola concerns and health care spending takes place on Wednesday, Nov. 6, after next week’s election.

 

 

October 24, 2014

Week in Review — Ebola: House Hearing Today; New Case Identified in New York; Airport Screening & Monitoring Revamped

A House committee today examines the coordination of federal agencies in responding to the Ebola crisis. The hearing session includes testimony from federal agency officials but excludes Centers for Disease Control and Prevention Director Thomas Frieden and the newly appointed federal Ebola response czar Ron Klain. The hearing is colored by a newly identified case in New York City. A doctor, who recently returned from an international aid mission in Africa, is now undergoing treatment at a New York hospital.

Testimony at this morning’s hearing will include an update on the U.S. military mission in Liberia and Senegal, where more than 630 U.S. military personnel have been deployed to build medical facilities and help with logistics. Also, the session will likely address Department of Homeland Security enhancements to the airport screening process. The process was adjusted this week to funnel travelers from West Africa to enter the U.S. through the five selected airports offering Ebola screening. An airline trade group noted that the change in itineraries would impact about nine people each day.

Additionally, the CDC is requiring all passengers arriving from Ebola infected countries to submit to post-arrival monitoring for 21 days, the standard period for incubation of the virus. The CDC this week also updated its guidance to hospitals on proper protective procedures for treating an Ebola patient.

Earlier this week, the remaining U.S. Ebola cases and persons under observation as a result of the initial Texas patient were gradually closing. In Africa, the World Health Organization announced the end of Ebola outbreaks in Senegal and Nigeria but a new case emerged this week in Mali. The pandemic continues in Liberia, Sierra Leone and Guinea.

 

 

October 21, 2014

Ebola: CDC Updates Guidance on Protective Gear and Drinking Chlorine

There have been no new confirmed Ebola cases in the U.S since October 15. But the last two cases were health care professionals treating the first – and only U.S. identified patient. The Centers for Disease Control and Prevention on Monday updated its guidance protocols for health care worker protective gear when treating an Ebola patient. The guidance and summary stresses a more thorough coverage of the body with protective equipment and urges rigorous training on donning and doffing protective suits. The new guidance follows some critiques offered last week on agency’s original guidance for protective gear.

The updated instructions are also accompanied by a separate warning to health professionals not to drink chlorine or disinfectant solutions. It is (hopefully) safe to assume that health care professionals know not to drink disinfectants but the CDC hopes to dispel a rumor that drinking chlorine can prevent the Ebola virus. Separately on Wednesday, the Department of Health and Human Services hosts a webinar on health worker protection and a previously released emergency room preparedness checklist.

 

 

 

 

 

October 17, 2014

CDC Tallies Vaccination Rates for Children in Kindergarten

The Centers for Disease Control and Prevention today issued its annual assessment of vaccination rates for children in kindergarten programs. The agency reviewed state data and reported that median vaccination coverage for the 2013-2014 school year was 94.7 percent for the measles, mumps, and rubella vaccine and 95.0 percent for the diphtheria, tetanus toxoid, and acellular pertussis vaccine. The overall rates are inline with the 95% national vaccination objective. However, many states allow varying levels of exemptions from vaccination due to religious or personal objections. The report records the median national vaccination exemption rate at 1.8 percent. The CDC noted that a high exemption level and failure to maintain vaccination targets could leave children vulnerable to vaccine-preventable diseases.

 

This Week: Congress Focuses on a Travel Ban and Ebola Response Funding

Lawmakers this week escalated calls for a travel ban for people coming from Ebola-ravaged West African countries. The pleas for travel restrictions culminated at a special recess House subcommittee hearing on Thursday (view C-SPAN video), where lawmakers grilled federal health and border control officials about their recent actions and missteps in managing the response to the first U.S. Ebola case. Republican members are leading the charge for a travel ban – or imposing restrictions on visas –but some Democrats have also endorsed the idea.

However, Centers for Disease Control and Prevention Director Thomas Frieden continued to insist this week that restrictions would only encourage people to avoid regular travel channels and limit governments’ ability to track those who have been exposed to the virus. The Economist, in an opinion that coincided with its cover article on Ebola published today, echoed the same reasoning for avoiding travel restrictions. President Obama told reporters at the White House on Thursday that he does not have a “philosophical objection” to a travel ban but is relying on advice from infectious disease experts, who say the current screening process is the best approach to managing potentially infected travelers.

Meanwhile, a separate congressional battle is brewing over added Ebola response funding for the CDC and the National Institutes of Health. Roll Call’s David Eldridge reported that Democrats are pressing for a separate hearing on Ebola response funding prior to the end of the recess break and claim the CDC cannot do its job adequately without more congressional appropriations. Roll Call’s Emma Dumain wrote that Republicans countered by noting that the CDC has not yet asked for additional funding. Also, CQ HealthBeat’s John Reichard reported (subscription) that hospital executives are scrambling for grant funding for technical assistance in managing Ebola cases, and CQ Roll Call’s Melanie Zanona noted (subscription) that health provider groups have ramped up calls for a boost in funding for a federal hospital preparedness program.

Other related Healthopolis reports on Ebola this week:

October 16, 2014

Study: Ebola Incubation Period May Exceed 21 Days

Doctors are watching those who had contact with the first domestically confirmed Ebola cases in Dallas using a standard 21-day waiting period to see whether a person exposed to the virus will develop an infection. The medical community came up with the standard for observation after past experiences with Ebola, but a study published on Tuesday in the journal PLOS Currents indicates that the virus’ incubation period could exceed 21 days for up to 12 percent of patients. The new research, authored by Dr. Charles N. Haas of Drexel University in Philadelphia, is based on analysis of past Ebola cases, along with data on the first nine months of the current outbreak.

The study noted in its conclusion:

 While the 21-day quarantine value currently used may have arose from reasonable interpretation of early outbreak data, this work suggests a reconsideration is in order and that 21 days may not be sufficiently protective to public health. Further, outbreaks such as the current West Africa EBOV are presenting an opportunity for careful collection of data sufficient to revise and update (perhaps in an adaptive fashion) such recommendations. It may be that incubation time itself is a function of intensity and nature of contact, which may also need to be considered. The estimate of appropriate incubation time would need to explicitly consider the costs and benefits involved in various alternatives, which would incorporate explicit computations from transmission modeling.

By Paul Jenks Posted at 8:28 a.m.
Disease Control

October 15, 2014

Ebola: Reviewing Legal Options to Restrict Travel

A consistent lawmaker concern regarding the U.S. response to the Ebola crisis has focused on the airport screening process and possible restrictions on travel from West Africa.  However, there are no direct commercial flights to the U.S. from Guinea, Sierra Leone and Liberia and suggested travel restrictions largely hinge on halting the issuing of visas.

Florida Republican Rep. Tom Rooney on Tuesday penned the most recent request to federal agencies for action on visa restrictions. The Department of State issues visas, the Department of Homeland Security’s Customs and Border Protection agency inspects all people who enter the country and the Centers for Disease Control and Prevention is tasked with preventing the introduction of communicable diseases.

The Congressional Research Service has prepared a brief summary for lawmakers on the legal authority of federal agencies to restrict travel. Federal travel restriction authority ranges from visa limits, “Do Not Board” listings of people with contagious diseases, plus Department of Transportation regulations on passengers with infectious diseases and pilot requirements to report illness they encounter during a flight. Federal and state agencies also can impose isolation and quarantine measures. The CDC’s quarantine authority is authorized for Ebola by a recently revised White House executive order.

 

 

By Paul Jenks Posted at 9:23 a.m.
Disease Control

October 14, 2014

European Report Questions Impact of Airport Ebola Screening

A House Energy and Commerce Committee panel on Thursday is set question Centers for Disease Control and Prevention Director Thomas Frieden on his stance against halting all commercial travel from West Africa. The administration last week announced new entry screening procedures at five U.S. airports, which compliments current exit screening at airports in West Africa.

However, this weekend the European Centers for Disease Control and Prevention issued a technical report on the effectiveness of airport screening procedures. The report says the value of exit screening at departing airports is low and the impact of entry screening at arriving airports is also minimal.

Among the report’s findings:

Overall, screening for EVD (Ebola Virus Disease) among travelers may detect a few contagious EVD cases over time. Given that exit screening is in place in the affected countries and the poor intrinsic performance of the methods available, entry screening for EVD is likely to have an exceedingly low yield and represents a high investment, which may only contribute to a limited extent, to the prevention of importation of the disease.

October 8, 2014

Pentagon Explains Military Role With Ebola Patients

The commander of the U.S. military response mission offering relief to the Ebola crisis in West Africa, Gen. David M. Rodriquez, gave a mission update on Tuesday. The Pentagon has dispatched up to 4,000 soldiers to the region with the original objective training local health care workers to treat Ebola but did not indicate any direct treatment of Ebola victims. However the mission, which features the operation of mobile medical labs, could come in contact with Ebola patients. Pentagon officials later noted that military technicians will only be testing specimen samples from suspected Ebola victims.

Here is a selection of press questions and responses from Gen. Rodriquez on the treatment of Ebola patients:

Question: Will any U.S. military personnel be involved in the direct treatment of any Ebola patients or in the training that health care givers — will they be — come into contact with any Ebola patients?

Gen. Rodriquez: No. Now, the mobile labs are different. But not for the majority of the force. The mobile are testing people, OK? And some of them will have the Ebola virus. Now, those are trained at the highest level of something like nuclear, biological and chemical. So they’re all trained at a very, very high level. And they’ve been — the one from Walter Reed has been operating there for many years, for example. And the two that we just deployed meet those standards of training.

Question:  … do you have enough of the personal protective equipment that you need? Or is there a shortage of that? And have you stockpiled any of this ZMapp, the treatment that was given to the two missionaries that had been proven in case troops are exposed to the virus?

Gen. Rodriquez:  … on the virus (treatment), we do not have that stockpiled. And right now, that is — you’ll have to get the expert opinion of the CDC, but that’s still to be determined whether it’s effective or not, and they have a date in the future when it — they may be able to tell whether it’s effective or not, so we are not stockpiling that. And last, we have sufficient personnel protective equipment for ourselves, and we will continue to make sure that that’s the way throughout the process.

Question:  And so we’ve been told repeatedly up to this point from this podium that, in fact, servicemembers are not going to come in contact with patients, and now we’re being told that that’s changing.

Gen. Rodriquez:  The lab — the labs are a separate specialty element of the force. So that’s — that’s probably where that has come. As far as the general population, they won’t be coming in contact. These are — like I said, these labs are trained to a specialty skill — level four, it’s called — but the bottom line, it’s the highest level. I mean, they can operate in a nuclear, biological and chemical environment. They are specifically trained to do that, and that’s their primary skill set, OK?

And we had one in there that has been operating for several years in the country that works on infectious diseases. We have the — both the Navy and the Army have medical labs in many countries doing just that, to monitor these things. OK?

 

October 6, 2014

Congress Mobilizes to Respond to Ebola

Congress is scrambling to react to the burgeoning Ebola crisis. A House panel has scheduled a rare recess period committee hearing next week with CDC and NIH officials to discuss the ongoing response to the crisis, now that a confirmed case has been reported in the United States.

The crisis has prompted some lawmakers to call for the consideration of travel restrictions on flights from West Africa and a public petition for a ban on travel has been added the White House’s public interest forum. However, there are no direct commercial flights to the U.S. from the primary West African countries struggling with Ebola. Passengers arrive in the U.S. through connecting flights, most likely through Europe. Several Democratic and Republican senators have called for considering immediate enhanced passenger screening. California senators offered a plea for improved hospital preparedness.

Separately, the initial reactions of the Ebola patient and Texas health providers has tested public health plans for a disease outbreak. The patient reportedly gave false information on an airport screening form and a Texas hospital released the patient after an initial emergency room screening. Afterwards, federal transportation officials scrambled to arrange for a special permit to transfer medical waste from the Dallas hospital. Also, a Texas television station photographed what appears to be a low-tech clean-up effort at the patient’s apartment building.

 

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