Thursday, October 16, 2014

Ebola and RVA

The last 72 hours have been exceedingly hectic as we worked through a suspected Ebola case. In the end, the much feared infection was excluded. As with many crises, many lessons are learned and many issues are still evolving.

The Richmond Times Dispatch published this editorial on our response to the Ebola threat. Today, our very own Dr. Richard Wenzel published this thoughtful commentary in the Richmond Times Dispatch. 

Other recent media include these print interviews where I am quoted, accessed here and here. A recent Channel 12 interview can be viewed here while a Channel 8 appearance is accessed here.

Monday, October 13, 2014

ID Week 2014

With Nadia Masroor at ID Week 2014
Last week was exceedingly busy at the ID Week 2014 conference. In addition to various SHEA related committee meetings, we presented our data on de-escalation of contact precautions for endemic MRSA and VRE (Presented by Dr. Michael Edmond).

Nadia Masroor presented our scientific abstract on perceptions and barriers to universal gloving.

Now I am back to work, back to the grind and back to Ebola emergency preparedness. 

Friday, October 3, 2014

Enterovirus and Ebola Media Attention

The last several days have been a bit of a media frenzy with Enterovirus and Ebola, both locally and nationally.

Here is a link to a WRIC Channel 8 television interview I did on both Enterovirus and Ebola.

Here is a link on another interview, with a focus on Ebola, for CBS Channel 6.

I also participated in a live Twitter chat, accessed here.


Monday, September 29, 2014

Death in the White House: William Henry Harrison

I am back on the infectious diseases consult service this week so my attention will be diverted to clinical care. Regarding infectious diseases cases, here is an interesting article published in Clinical Infection Diseases titled Death in the White House: President William Henry Harrison's Atypical Pneumonia.

The article challenges the long maintained notion that pneumonia killed William Henry Harrison (1773-1841) just 1 month after he became the ninth president of the United States. A careful review of the detailed case summary written by his personal physician suggests that enteric fever, not pneumonia, was the disorder that killed the president.  

Although President Harrison did have some pulmonary symptoms, the case summary highlights the progressive abdominal symptoms that ultimately led to sepsis and death. Emphasis is placed on the unsanitary condition of early 19th century Washington, DC. The water supply of the White House was 7 blocks down from a repository of ''night soil", a euphemism for human feces. Given that a sewage system was non-existent, runoff most likely contaminated the water supply, increasing the likelihood of enteric fever. 

I previously blogged about the death of President Garfield, as chronicled in the Destiny of the Republic, another worthwhile read.

Then, as in now, physicians subscribed to the tenet of primum non nocere. Ironically, unbeknownst to them, the treatments, both in the cases of Presidents Garfield and Harrison, were toxic and led to greater harm than good. 

Good intentions, bad results.

Tuesday, September 23, 2014

Seeing the Invisible

I am back to my medical blog after a much needed break.

In honor of Anton Van Leeuwenhoek, the founder of the microscope, I refer you to this animated video from the New York Times titled Seeing the Invisible.

As an infectious diseases specialist I have plenty of respect for microbes. The goal is not to kill or eradicate all bacteria, rather, to target treatments such as to minimize adverse consequences, maintain our homeostasis and preserve the symbiosis between man and microbes.

Monday, September 1, 2014

A Systematic Review of Mandatory Influenza Vaccination in Healthcare Personnel

Here is an article published in the American Journal of Preventive Medicine that provides the most up to date assessment of mandatory influenza vaccination of healthcare workers.

This can be a very emotionally charged subject for many people. What evidence is there to support mandating the influenza vaccines in healthcare workers?Twelve observational studies were included in the study from 778 citations. The data suggest that implementation of a vaccine mandate will without doubt increase vaccination of healthcare workers, exceeding 94%. 

But what are the health benefits for healthcare providers and patients? This is much less clear. Two single-institution studies reported limited, inconclusive results on absenteeism among healthcare workers. We still cannot answer whether vaccination will result in fewer sick days by staff. Importantly, no studies reported on clinical outcomes among patients. 

We simply do not know if mandatory vaccination of healthcare workers will result in improved patient safety as the appropriate studies have not been done.

Mandatory influenza vaccination of healthcare workers is not backed by sound evidence, either for staff or patient outcomes. This is disappointing and mandatory vaccination may be an overreach.

Fortunately, the vaccine is safe.

Friday, August 29, 2014

What Can Fourteenth Century Venice Teach Us About Ebola?

Plague Doctor's Mask
What can fourteenth century Venice teach us about Ebola? 

Here is an interesting perspective published in Environment Systems and Decisions. Venetian authorities focused on managing physical movement, social interactions, and data collection for the city as a system. This included the creation of lazarettos (quarantine stations) on nearby islands, quarantine periods, and wearing protective clothing (plague doctor's mask).

With the present Ebola outbreak, we are reminded of the importance of emergency preparedness, patient isolation for infection prevention, the use of personal protective equipment and the need for cultural/practice changes in African countries (limiting both contact with sick individuals and post-mortem contact) so as to further limit person to person cross transmission.

Plague and Ebola, different illnesses, different pathogens, some historical parallels.