Is Yellow Fever Knocking At Our Door?

25 04 2017

The following article was passed along to me by David Olinger, the County’s Public Health Preparedness Coordinator.  It is an article that is written by Michaeleen Doucleff and published by Houston Public Media News 88.7

It is a good reminder that, even as we prepare for hazards that we know too well (like river flooding and hurricanes), everybody needs to be equally prepared for hazards that come from the public health realm.  Back in 2009, it was H1N1.  Then it was Ebola a couple of years later.  And then last year it was the Zika virus that still is hanging around causing problems.  As the author says—- is Yellow Fever the next infectious disease we will have to worry about in the Houston area?




Scientists love patterns.

It’s what makes science possible — and powerful — especially when it comes to infectious diseases.

Over the past 30 years, scientists have noticed a distinctive pattern of mosquito-borne diseases in the Western Hemisphere: Three viruses have cropped up, caused small outbreaks and then one day — poof! — they hit a city and spread like gangbusters.

All three viruses are carried by the same mosquito, called Aedes aegypti. All three have caused millions of cases in Latin America and the Caribbean. And all three have gotten a foothold in the U.S., causing small outbreaks.

Now there’s a fourth one lurking in the Brazilian rain forest, says Dr. Anthony Fauci of the National Institutes of Health. It’s familiar. And it’s deadly: yellow fever.

In a recent commentary for the New England Journal of Medicine, Fauci and his colleague Dr. Catherine Paules explain the pattern seen across Latin America and how the historical information could help us intercept the next epidemic.

The waves of epidemics from the three other viruses started in the 1990s.

First dengue — a nasty virus that can cause hemorrhaging — re-emerged in parts of Latin America after it had been eliminated in 18 countries.

Next up came chikungunya. The virus first appeared in the Caribbean in 2013. It hopped around the islands for a few months and then finally hit the mainland of Central and South Americas, where it caused debilitating joint pain in thousands of people.

Then last year, Zika emerged as the first mosquito-borne virus that can cause birth defects. Still today, the U.S. is seeing about 30 to 40 Zika cases in pregnant women each week.

“Now all of a sudden you start to see this very interesting clustering of yellow fever cases in Brazil,” says Fauci.

The outbreak started in December and has swelled to about 600 confirmed cases and more than a thousand suspected cases, the Brazil Ministry of Health reports. Symptoms can include fever, nausea and muscle aches. In about 15 percent of cases, the disease progresses into a toxic phase, which can include jaundice, bleeding and organ failure. There have been about 200 deaths in Brazil.

“That’s a potential threat,” Fauci says.

So far, the disease is still isolated to a rural area, Fauci says. And it’s spreading only among mosquitoes that live in the forest and not in mosquitoes that thrive in cities, called Aedes aegypti.

But that scenario could change quickly, Fauci says, if Aedes aegypti picks up the virus from infected people.

“If Aedes aegypti mosquitoes start spreading yellow fever in Brazil, there’s a possibility that you might have an outbreak in very populous areas in Brazil, such as Rio de Janeiro and Sao Paulo,” Fauci says.

“Whether that’s going to happen, I don’t know. But if it does, we’re going to get a lot of travel-related cases in the U.S.,” he says, “which means physicians here have to be aware of it.”

And that’s why Fauci penned the commentary: To alert public health officials and doctors so they won’t miss cases.

“This is a wake-up call,” Fauci says. “Be careful. If someone comes in with an illness that’s compatible with the yellow fever, you might want to ask them, ‘Have you traveled to this part of Brazil?’ “

But there’s another reason to keep an eye on yellow fever in the Americas. Unlike Zika, chikungunya, and dengue, the world actually has an effective way to prepare for an outbreak. We have a vaccine that is 99 percent effective.

“That’s really an amazing asset,” says biologist Erin Mordecai, who studies infectious diseases at Stanford University.

“So this is a great example of a time that we could be proactive,” she says. “We have a good vaccine, and we need to make sure that there’s enough available in the case of a large outbreak.”

And right now, that’s a bit of a problem, Fauci says. The world’s supply of the yellow fever vaccine is low. There aren’t enough doses to protect Brazil’s population of 200 million, not to mention the rest of Latin America.

“We don’t have enough vaccine. Period,” he says. “We’re going to have to make more vaccine. And that will take time.”

In the meantime, predictions that Brazil’s outbreak would burn out quickly have turned out to be wrong. The outbreak continues to grow while health officials make deep cuts into the vaccine stockpile.

Studies explore working in a pandemic, working sick

2 10 2010

The Center For Infectious Disease Research & Policy (CIDRAP) recently issued a report shed some light on the ability and willingness to work during a pandemic.  Lisa Schnirring, CIDRAP News Staff Writer, notes in her article published on September 30, 2010:

A new study suggests that about half of essential workers, such as police and emergency medical personnel, might be unwilling to work during a serious pandemic. Meanwhile, another study indicates that it’s common for employees in private industry to work while sick with flu-like symptoms.

Both studies were published on Sep 25 in an early online edition of the Journal of Occupational and Environmental Medicine.

In the first study, the goals of researchers from Columbia University’s Mailman School of Public Health were to assess the ability and willingness to work specifically during a pandemic and to gauge the opinions of not just healthcare workers, but also—for the first time—workers from other essential sectors such as police, emergency services personnel, public health workers, and corrections officers.

Researchers in the second study conducted a monthly survey of workers from three US companies to explore if flexible sick leave policies influenced employee decisions to work while sick with a flu-like illness.

The US Centers for Disease Control and Prevention (CDC) has addressed both topics—risky work settings and flexible sick leave policies as a possible social distancing measure—in its pandemic guidance materials for employers.

Working in a severe pandemic setting
The Columbia University researchers recruited workers from Nassau County, in the New York City metropolitan area. The anonymous surveys asked employees about their ability and willingness to work during a serious pandemic. It was conducted from November 2008 to June 2009, a time that overlapped the first few months of the H1N1 pandemic. The survey also asked workers about their flu vaccination history, respiratory protection knowledge and use, workplace climate and trust, and employer pandemic planning.

They found that though 80% of workers would be available to report for duty in a severe pandemic, only 65% were willing. Less than 50% of the essential workers were both willing and able to report for duty. The proportion who said they were willing ranged from 56% in correctional workers to 74% in public health employees.

Investigators found that ability to work during a severe pandemic was closely linked to personal obligations, such as caring for children or sick family members.

Dr Robyn Gershon, professor of clinical sociomedical sciences at Columbia’s Mailman School of Public Health, said in a Sep 28 press release that employer policies and programs can help workers meet their home obligations. “Even something as simple as making sure workers can communicate with their families while they are on duty can have a big impact on ability and willingness,” she said.

Among other findings, authors learned that participants had little confidence in respiratory protection, but would wear it at work in a pandemic setting. Only 9% reported they were aware of their employers’ pandemic plans, and only 15% said they had received training.

In what they called a surprising finding, the group found that 12% of study participants would consider retiring or leaving their jobs rather than reporting for duty in a severe pandemic. They said that outcome is a concern, due to a rapidly aging US workforce, many of whom are public service workers. “The development of strategies to retain these most experienced workers during public health emergencies remains an area for future exploration,” they wrote.

The authors recommended other simple strategies that employers can use to boost employee support during a pandemic, including a plan to vaccinate essential workers and their families as soon as a vaccine is available, getting guidance in advance about respiratory protection needs, and making sure employees know about the workplace pandemic plan.

The study group included many workers who were involved in the response to the Sep 11, 2001, World Trade Center terror attack, and the authors wrote that they, like other workers in the area, are “highly motivated and altruistic.” They cautioned that other workers in other areas might not be as responsive, and they recommended that further studies include essential employees in other geographic areas along with other types of essential workers, such as those in telecommunications, transportation, and commerce.

Which policies keep sick employees home?
In the flexible sick leave study, researchers recruited employees from three large US firms—a retail chain, a durable goods manufacturer, and a transportation company—and used a Web-based survey tool that asked them each month between November 2007 and April 2008 about flulike illnesses and workplace attendance. They also collected demographic information and details about employer-provided flexible sick leave policies, such as ability to work from home, adjustable working hours, or time off without pay.

Among 793 employees who said they were sick with a flulike illness, average duration of a severe infection was 3 days. About 72% said they worked while they had severe flu symptoms, on average for about 1.3 days.

The only flexible sick leave policy that was associated with working while sick was the ability to work from home. Those who were able to telecommute were 29.7% less likely to come to work sick with severe flu symptoms.

Researchers pointed out that the study is one of the first evaluations of the CDC’s recommendation to institute flexible workplace policies in advance of flu season.

They recognized that though social distancing makes sense, employers who are setting their personnel policies must weigh possible unintended consequences of telecommuting, such as shirking work responsibilities, against the drawbacks of working while sick.

However, they wrote that the ability to work from home minimizes the economic impact of the employee being away from the workplace.

The group concluded that the findings support CDC social distancing recommendations for flu seasons. “When feasible, employers that implement teleworking policies may be able to effectively reduce the likelihood of employee-to-employee transmission of respiratory illnesses, such as seasonal of pandemic influenza,” they wrote.