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October 21, 2014

Posts in "Disease Control"

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.


October 3, 2014

U.S. Ebola Case Spotlights Domestic Health Response Issues

The congressional response to the Ebola crisis, so far, has focused on hearings about the outbreak in West Africa and assembling initial funding for the U.S. international response effort. Congressional reaction has largely been supportive of U.S. response efforts. However, the first case of a patient diagnosed with Ebola in the United States opens up broader questions on domestic public health issues.

Last week, lawmakers began the partial transfer of Pentagon funding for military-led assistance in Africa. Last month, a stopgap spending bill added additional funds for HHS and CDC Ebola research and response activities. This week, the Texas Ebola case caused CDC and state health officials to scramble to examine 100 people who had contact with the diagnosed patient.

Also this week, Texas Republican Sen. Ted Cruz inquired about new FAA travel restrictions. Texas Republican Rep. Michael C. Burgess, who is also a physician, suggested an examination of the possibility of suspending travel from selected countries. CQ Roll Call’s David Harrison reported (subscription) on the current CDC position, which allows travel from Africa.

Additionally, isolating an Ebola patient poses expensive logistical concerns for health care providers. If additional domestic Ebola cases emerge, local officials are likely to seek additional federal financial assistance. Also, segregating Ebola patients opens up an examination of the existing authority of federal and state agencies to isolate and quarantine patients. Here is a 2007 (the most recent) Congressional Research Service primer on quarantine authority.





October 2, 2014

Doctor in Congress Reacts to Ebola Case in His Home State

The CDC is confident it can stop the U.S. case of Ebola in it’s tracks, but some conservatives in Congress aren’t sure the government is taking all the necessary precautions.

CQ Roll Call got on the phone with one such member, Republican Rep. Michael C. Burgess of Texas, to get his opinion as a congressman, as a former physician and as a Texan (the Ebola patient was diagnosed in Dallas) on next steps to contain the disease. Burgess spoke to CQ on Tuesday (subscription required) about the need for more medical professionals to become lawmakers.

Airline travel

Burgess said one way to address the spread of Ebola is to evaluate the screening process that individuals undergo when flying out of the African countries in which the disease is widespread. “It does raise some serious questions about the type of screening that’s going on in Liberia. Apparently this person showed no evidence of being ill when they boarded the plane,” he said.

He also said that the U.S. might want to consider suspending travel from Liberia and the other countries where the disease is prevalent: “We still have planes coming from Liberia to DFW, I guess. I wonder if someone ought not to rethink that.”

Health care privacy laws

Burgess said if other cases of Ebola are found in the United States, it might be easier to reach and educate those who come into contact with the disease if sick individuals’ names are made public more quickly.

“Perhaps some of the rules regarding patient privacy may need to be reconsidered in light of the public health threat, if indeed there are more cases that appear as a consequence of this individual being here or as a consequence of someone new coming in with [Ebola] that was unrecognized when they arrived.”

He later added, “This job may be made easier if there’s not quite the fealty to the privacy aspects as we normally employ them.”

Pace of government action

Burgess said he would also like to see at least one government agency pick up its pace in response to the Ebola threat.

“The fact that the FDA is taking its normal, bureaucratic approach to the evaluation of medicines and vaccines, I think this is a different day and I would like for them to recognize that,” he said. “The normal, bureaucratic lethargy that is tolerated on a day-to-day basis in Washington, this may be a time where it can’t be tolerated in the interest of public health.”

September 29, 2014

Ebola Patient Arrives at NIH; Congress Slowly Releases Ebola Response Funds

On Sunday afternoon, the National Institutes of Health received its first Ebola patient. An American physician who was volunteering services in an Ebola treatment unit in Sierra Leone and was exposed to the virus was admitted to the NIH Clinical Center’s high-level isolation unit.

Meanwhile, congressional appropriators are slowly releasing the requested transfer of funding for the U.S. Ebola response effort in West Africa. Roll Call’s Humberto Sanchez and Niels Lesniewski reported on Friday that the approval of the transfer of the entire $1 billion request is held up pending further details on Pentagon plans to keep soldiers from contracting the illness.

Appropriations and defense committee leaders have released only portions of the request. The partial release of funding, which would have expired at the end of the last week, allows the Pentagon to spend $100 million of the funds while lawmakers await details of how the funds will be used.





September 26, 2014

Weekly Spotlight: Ebola Crisis Entices a Global Health Focus

President Barack Obama today address a summit of international health leaders at the White Hosue. The president and cabinet officials will tout the administration’s global health agenda, which is shadowed by the ongoing Ebola crisis in West Africa. On Thursday, the assembled health leaders met (view broadcast) to encourage non-governmental organizations to join in on an effort to create a worldwide system to get ahead of threats like Ebola. In a Thursday speech at the UN, Obama exhorted world leaders to ramp up their response efforts on Ebola.

However, an expanded international health crisis response program will require Congress to appropriate funds beyond the $1 billion the administration is seeking to establish treatment units and train and equip health care workers in West Africa. This week, a quirky funding transfer approval process inched toward final approval of shifting Pentagon funds toward the U.S. Ebola response plan.

Committee chiefs from congressional defense and appropriations panels must sign off on the transfer requests. CQ Roll Call’s Megan Scully reported on Wednesday that House appropriators have approved the request subject to additional details on goals and a mission timeline. A separate Associated Press report on Wednesday noted that a Senate defense committee transfer request sign off is still pending.

Meanwhile, CDC Director Tom Frieden this week spoke to congressional staffers at a seminar on the Ebola outbreak (view C-Span broadcast) and Roll Call’s Hannah Hess reported on the reaction to a display of Ebola containment devices on display in a House office building.








September 16, 2014

Ebola: U.S. Ramps Up Funding and Response Personnel; Cuba Joins In Too

The House today is busy debating a stopgap spending bill, which includes additional funding for federal health agency efforts to combat the spread of the Ebola virus in West Africa. Separately, President Obama is in Atlanta today to announce a revamped effort – including a Pentagon plan to construct treatment centers in the region. The new plan calls for the deployment of 3,000 U.S. military personnel and 65 officers of the U.S. Public Health Service and adds to the 120 American personnel already sent to the region. The U.S. Ebola response effort so far has spent $100 million, the Pentagon is transferring $500 million to fund its mission and the pending continuing resolution seeks to add $88 million to address the crisis.

Separately, the increase in the direct U.S. response on the ground to the Ebola crisis parallels efforts by Cuba, which announced last week that it is sending 165 medical workers to Sierra Leone. CQ HealthBeat’s John Reichard (@CQHealthTweet) reports that Cuba has a history of sending medical staff to Africa.



By Paul Jenks Posted at 11:37 a.m.
Disease Control

September 10, 2014

Congress Offers Ebola Response Funding; Health Care Volunteers Are Needed in Africa

House appropriators on Tuesday evening unveiled details of a fiscal 2015 continuing resolution to fund the government into the new fiscal year. The measure stretches funding through Dec. 11 and provides an extra $88 million to fight the Ebola outbreak in West Africa. The added funding matches the administration’s request to support medical specialists on the ground in Africa and speed the development and manufacturing of Ebola drugs.

Congress’ role in addressing the threat of the Ebola virus focuses on providing funding for medical supplies and drug and vaccine research. However, halting the spread of the disease will hinge on finding enough health professionals willing to volunteer. HealthBeat’s (@CQHealthTweet) Rebecca Adams (@RebeccaAdamsDC) reported Tuesday on the profound challenge of enticing health professionals to volunteer to go to Africa to directly assist in efforts to combat the spread of the virus.

The World Health Organization estimates that 760 foreign volunteers will be needed at any one time over the next six months to monitor infected people, test lab samples, run logistical offices and disinfect thousands of corpses. The global WHO appeal so far has generated only a handful of responses and the agency estimates that as many as three health care workers are needed for each patient. The gruesome impact of the virus on the human body and the paucity of proven drugs and a viable vaccine hinders the task of recruiting volunteer health workers.


September 9, 2014

IG Blast Homeland Security’s Pandemic Preparedness Program

In 2006, Congress appropriated $47 million to the Department of Homeland Security (DHS) to prepare federal employees for a possible influenza pandemic. The objective of the program was to ensure that employees were protected from a pandemic and could continue DHS security operations.

On Monday, the DHS Inspector General reviewed spending on the program and determined that the program acquisition process was mishandled. CQ’s Jennifer Scholtes (@JAscholtes) reported that auditors critiqued the department for not adequately taking stock of the department’s needs or developing a clear plan for how much and what types of equipment and antiviral medication to buy. The agency accumulated 300,000 courses of antiviral medical countermeasures without examining the department’s actual needs. The department also purchased 350,000 coverall suits, and 16 million surgical masks. Additionally, of the 5,000 bottles of hand sanitizer purchased under the program, 84 percent of the bottles have expired expiration dates.

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September 8, 2014

Spotlight: White House Suggests Additional Ebola Response Funding

Congress returns this week with the primary objective of forging a stopgap spending bill extending existing federal spending in order to avoid a federal agency shutdown at the end of the month. On Friday, the administration added additional Ebola response funding to a list of requested immediate spending adjustments and transfers — called “anomalies,” to address additional critical funding requirements. CQ HealthBeat reported that the administration’s spending adjustment request includes the transfer $10 million from existing accounts into a new fund to respond to the crisis and $58 million in new funding for Department of Health and Human Services drug research to accelerate the development of Ebola drugs and vaccines. Separately, the U.S. Agency for International development has allocated $75 million from current funds to respond to the outbreak.

White House budget planners want congressional appropriators to add the additional funding to a continuing resolution, which would fund the federal government beyond the Oct. 1 start of the new federal fiscal year. The continuing resolution is expected to provide stopgap funding from October until mid-December. Separately, a group of House Democrats last week pressed Republican leaders to schedule a hearing prior to the end of the month on U.S. efforts to fight the spread of the Ebola virus in West Africa.

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