Monday, October 27, 2014

Visiting Professorship, Airport Screening for Ebola

Medical Library- University at Buffalo
I spent last week at the University at Buffalo School of Medicine and Biomedical Sciences as a visiting professor (Infectious Diseases). Given that UB Med is my medical Alma Mater, this was a huge honor for me.

Butler Auditorium- University at Buffalo

I am back at VCU, seeing patients and collaborating with many others on our ongoing Ebola preparedness. Although not immediately relevant to our Hospital Infection Prevention Program, I am frequently asked my opinion on airport screening and travel bans. 

This editorial published in  the British Medical Journal summarizes much of the key arguments on Ebola screening at airports. Even as we embark on airport screening, we should not fool ourselves that it will be an effective mechanism to limit the entry of Ebola into the USA. A review of the evidence, particularly for mass screening at airports during the SARS epidemic, suggests that screening, including thermal scans, will detect few cases. Many will not self report symptoms. Also, the longer the incubation period of the infection (up to 21 days for Ebola), the greater the chance of being asymptomatic at the time of screening.

Airport screening may give us a false sense of security. Efforts and resources should be directed at mass public health messages on where to seek prompt medical care  for those at risk of Ebola virus disease. 

More importantly, resources are needed on the front, in west Africa.

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.