The Age of Endemic Ebola

Highlights

Total Cases in 2018: 341

Total Deaths in 2018: 215

Case Fatality Rate: 63%

Pandemic Threat Level: 7/10

This week, I’d like to talk about Ebola. I don’t know if you knew this- but right now there is an objectively worse outbreak of the disease going on than what we saw in 2014 when it infected almost 30,000 people across West Africa. I’m sure many of you remember this outbreak. It was the first time the hemorrhagic fever had been seen on such a massive scale, killing anywhere between 60 and 90 percent of all it infected.

The symptoms of Ebola are not for the faint of heart. It begins with flu like symptoms, making it difficult to diagnose at the beginning. Then, as the disease progresses, it can lead to vomiting, diarrhea, and stomach pain. Most startling, however, is the final stages of the disease. You see, by the end, the victim’s organs have begun to liquefy causing blood to pour out of every orifice of their body before they are finally allowed to succumb to death. During all of the stages, the disease is contagious to anyone who comes into contact with the bodily fluids of the infected.

When Ebola hit West Africa in 2014, the scale of the outbreak was unprecedented. World Health Organizations barely knew how to handle it, and in fact have stated numerous times since then that they did not handle it as well as they could have. The outbreak led to some cases spilling over to the United Kingdom, the United States, Spain, Mali, as well as others. Eventually, over two years later, the disease disappeared back into the forest and health organizations declared the outbreak over.

The current outbreak has shown up in the Congo, in an area that was no stranger to the disease. So far, it’s infected over 300 people.  Compared to 30,000 people, this number seems frightfully low to even consider this a serious outbreak. However, there is one key difference between this outbreak and any other Ebola outbreak that has occurred before this.

Historically, Ebola outbreaks always have a source. Even when epidemiologists were tracking the 2014 Ebola outbreak, each cluster was connected to another cluster. Let me explain how this works- using the 2014 outbreak as the example. In 2013, an 18 month old boy in Guinea contracted Ebola virus and died in late December. It would be almost an entire year before he was identified as the source of the outbreak. Working backwards through disease serotyping and interviews, epidemiologists were able to trace the path of the outbreak (through thousands of infected) to determine that the entire outbreak had been started by this young child. When jumping from one location to another, or from one population to another, epidemiologists are often able to follow the path a disease travels. So, as mother gives it to son, son gives it to friend, friend to cousin, cousin to shop owner, and so on, epidemiologists are often only a few steps behind course. Such investigative work is often responsible for developing the best measures to put into place to prevent the disease from spreading further.

However, for the first time ever, this isn’t the case for the current Congo outbreak. In fact, almost a third of all new cases that healthcare workers are seeing are coming from unknown origins. They are completely untraceable. Every day in the Congo, daily cases are steady with no sign of decreasing any time soon, and many of them are showing no connections with known sources. The fact that many cases are untraceable proves that we are entering a new era of Ebola outbreaks- the era of endemic Ebola. Soon, it won’t be a matter of responding to new outbreaks- efforts will instead need to be placed on controlling the never ending cases of infected.

It takes the transmission of infected bodily fluids to spread the virus, and Ebola cannot be spread from one person to another when the infected person shows no signs or symptoms of having the disease. That being said, the virus can survive inside its host for 2-21 days before an infected person may began exhibiting signs and symptoms. In the 21^st century, a person can be anywhere they want to be in the world in a lot less than 21 days, and without being able to track the disease- it’s only a matter of time before we’ll see Ebola show up naturally outside of Africa.

I gave this disease a 7/10. In 2014, when rating the same virus, I would have probably given a 5/10 or 6/10 because of its traceability. One of the resources we have that we didn’t have in 2014 is the emergence of an Ebola vaccine. The administration of the vaccination to 30,000 people in the Congo is widely accepted as the main reason why the numbers of infected aren’t higher. However, the Ebola vaccination is still in its human trials, and is only being used in the Congo in a “compassionate use” capacity in an attempt to curb the current outbreak (where the plan is working). This means that the vaccine is also only given to patients who have had direct contact with the disease or diseased patient. Well, those and healthcare workers. So, while this does help to limit the spread of the virus among known routes, it still leaves a big question over the “untraceable” outbreaks.

Ebola is about to be at a larger turning point than we could have ever expected. It’s possible we are hitting an age when outbreaks of Ebola are no longer newsworthy and are considered common- much like each new malaria or cholera outbreak. Regardless of the path Ebola takes, we should never forget the bravery and selflessness of the healthcare workers who work tirelessly in often overcrowded and underfunded facilities to give help to those suffering. Each one of them does so at great personal risk to their own health- and in many cases are separated from their families while they do so. Our best hope now lies with the completion of the human trials and an effective deployment of the vaccine.

Hepatitis in Kentucky: Fifth State for the Outbreak

Highlights:

Cases since 2017: 2159

Deaths since 2017: 14

Case Fatality Rate: <1%

Pandemic Threat Level: 5/10

Hepatitis A has been spreading across the state of Kentucky in recent months, infecting over 2,000 people. Part of a family of viruses, hepatitis A is a liver disease that is easily transmitted from person to person through the fecal-oral route. For those of you who don’t know what the “fecal-oral route” is, it’s essentially how bacteria and viruses can be transferred when a person uses the restroom and does not wash their hands afterwards. The unwashed hands then go on to prepare food, wipe their face, shake YOUR hand where you then wipe your face… you get the picture. Some of the most contagious viruses can be spread this way, such as norovirus (commonly known as the stomach flu).

There are three viruses that make up the Hepatitis family and they are known as A, B and C. All hepatitis subtypes are known for infecting the liver, but each has their own rules for transmission and severity. Hepatitis B, for instance, is transmitted via body fluids (specifically blood or semen) and can cause many flu like symptoms as well as jaundice, abdominal pain, and dark urine. Most of these infections clear up on their own. Sometimes, however, hepatitis B can become recurring and becomes known as a chronic illness. Hepatitis C, on the other hand, is much more serious and is transmitted via blood. Because of this, it most often affects intravenous drug users. For about 70-85% of its victims, hepatitis B becomes chronic and can lead to cirrhosis and liver cancer.

Hepatitis A, the particular viral subtype of this story, is the easiest to transmit of the three viruses, but is also the least serious. In most cases, the disease does not result in a chronic ailment, but it can produce stomach pain, jaundice, fatigue, and low appetite for upwards of two months. As stated earlier, hepatitis A is often passed via the fecal-oral route, but can also be transmitted when contaminated food or water is consumed.

Around this time last year, I was doing an internship at the Kern County Department of Public Health when I heard about a hepatitis A outbreak in San Diego that was being tracked and moving up to Los Angeles. When the strains found in Kentucky were sequenced and compared to the strains found in the outbreak in California, it was determined that the two strains were linked. In other words, the outbreak in Kentucky is part of the same outbreak that had been occurring in California. Hepatitis A has also had epidemics occur in Utah, Florida, and West Virginia- all with the same strain of virus.

In all five states where the outbreak has occurred, hepatitis A has affected primarily the homeless and drug user population. This population is at the highest risk of coming into contact with contaminated food and water, and having limited access to hygienic practices. The transient nature of the homeless population can likely explain how the virus has been able to travel across so many states in a relatively short amount of time.

It is because of these factors that I rated hepatitis A at a 5/10 on the Pandemic Threat Level. However, it did not merit a higher number than 5 due to the nature of the illness. While it is very contagious, simple handwashing practices can help prevent transmission and the virus is vaccine transmittable. In many cases, just supplying adequate sanitation to homeless people and substance abusers has shown to merit some success in preventing the outbreak from spreading.

Cholera on Hispaniola- An Ongoing Story

Highlights

Cases since 2017: 17, 027

Deaths since 2017: 200

Case Fatality Rate: <1%

Pandemic Threat Level: 3/10

Cholera is a waterborne illness known for causing severe, watery diarrhea. In some cases, the symptoms can become so drastic that the body succumbs to dehydration. It can be spread through contaminated water, and sometimes death can come just hours after the first symptoms present themselves.

The outbreak of cholera in Haiti has been continuous since shortly after an earthquake decimated the infrastructure in 2010. In the eight years since its first reporting, cholera has killed at least 10,000 people in the small country, and is still running rampant across the island- even spreading into the Dominican Republic, though not as widespread.

Cholera had not been seen in almost century in Haiti until after 2010, and when it hit, the flooding and poor hygiene that was rampant in the area post-earthquake allowed the disease to spread like wildfire. In fact, throughout history, we have often seen rises of epidemics immediately following a natural disaster. Even more so with waterborne illnesses, since clean water can become hard to come by after earthquakes, floods, hurricanes, and other disasters.

Another contributing factor was the Haitian peoples own immunities. As cholera had not been seen in almost a century, the Haitian people had practically no natural immunities to the disease. Think of the stories of smallpox covered blankets being administered to the American natives. In the same manner, the natives had no immunity and were almost wiped out by smallpox. The Haitian people’s own lack of immunity has only helped to promote this outbreak, and has made it difficult to eradicate.

It wasn’t until years after the disease had already become endemic to Haiti that the source of the outbreak was discovered. In 2016, the United Nations admitted that Nepalese UN peacekeepers had brought cholera into the country with them when they had come to help with earthquake recovery. The disease started near the Nepalese camp, where it was discovered that the peacekeepers had dumped their sewage into local waterways.

Now, in the 8^th year of the outbreak, the disease remains endemic to Haiti, and even if the outbreak is finally brought under control, it is unlikely to be completely eradicated. The introduction of cholera from Nepal to Haiti is a great example of how easily it is in this century for diseases to spread from one location to the next. Historically, civilizations could rely on great mountain ranges and oceans on separating them from their next epidemic, but this isn’t the case anymore. We are all just one flight away from introducing a new disease to a defenseless population.

I gave the Haiti outbreak a Pandemic Threat Level of 3 because of its mode of transmission. Cholera is a waterborne disease and often thrives in locations that do not have water filtration systems. This is why it was so easy to transmit across the island of Hispaniola after the 2010 earthquake. In developed countries that have working water filtration systems, cholera is less likely to be spread. And while cholera is one of the most common diseases seen in developing countries, there are rarely any incidences in the western world.

Cholera can become life threatening in just a matter of hours, but there are ways to prevent its transmission even in endemic regions. Those in infected areas should be sure to wash their hands with warm soap and water and boil any water that could be contaminated before using it for food or washing. But even once infected, modern medicine can do a lot to curb the risk of death. It is also possible to make a homemade solution of water, sugar, salt, baking soda, and fruit to help restore electrolytes of the infected. There is no cure for cholera.

Prenatal TDap Vaccination: Preventing Whooping Cough in Infants- A Thesis (Part 2)

Last week, I wrote on the importance of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccination for pregnant women, and included the introduction to my thesis paper in order to illuminate the problem, as it stands, in California. I discussed the 39% rate of prenatal vaccinations in Kern County and had just began to postulate what could be causing such a low rate. My research did not take me down the route of talking to pregnant women and determining their opinions regarding vaccination. Instead, what I wanted to focus on was the source of prenatal vaccinations and accompanying education- prenatal care providers.

This research targeted the doctors and nurse practitioners who administer prenatal care in Kern County, CA. What were the doctors’ attitudes regarding prenatal Tdap? How educated were they on the necessity and timeframe for administering the prenatal Tdap? In order to obtain the answers to these questions, I (with the help of the Kern County Department of Public Health) created surveys aimed at asking the doctors many questions regarding their practices and processes. I’ll summarize my findings here, but check out the link below to access my completed thesis (with charts included)!

One of the interesting things that I noticed about prenatal care providers was that not all of them were recommending the vaccination at 28 weeks. 28+ weeks of gestation is the widely accepted time for administering the vaccination due to the fact that this is prime time for antibodies to be shared between mother and fetus, while still giving both enough time to build up immunities. Some doctors, however, recommended the vaccine outside of this accepted window. A few doctors suggested the vaccine as early as 12 weeks, while some would not administer until the patient delivered her child.

You see, the 28+ weeks timescale is very important when it comes to administering Tdap to expectant mothers. Administer it too early, and the fetus may not be developed enough to make use of the fresh supply of antibodies. Delivering it too late, such as at delivery, will protect the mother- but does not give enough time or ability to also spread immunity to the child.

I also looked at whether or not practitioners stocked the shot at their facility. The reason this question was so important was due to the fact that prior research has shown that when patients are referred to a secondary location to receive their vaccination, they are much less likely to follow through with their referral. For example, when it came to prenatal flu shots, patients were only 33.5% likely to receive their flu shot when they were referred, compared to 67.9% when it was administered at their doctor’s office. Let me clarify this… women were almost doubly likely to get vaccinated when they were able to receive their shot at their doctor’s office, rather than when they were sent to the nearest pharmacy.

In Kern County, 77% of private practitioners do not currently stock the vaccine at their location and instead rely on referrals to ensure their patients become vaccinated. The referrals, however, are little more than suggestions. In fact, most private practitioners verbally referred their patients- with only half even documenting their referral in the patient’s chart. What’s even more, is that there is virtually no follow-up occuring in practitioners’ offices. In most cases, doctors will recommend the prenatal Tdap once, and then never mention it again.

When patients actually followed the referral and received their shot, only 27% of private practitioners in Kern County documented such in their records. When it came to documenting patient refusals, however, practitioners were much more likely to do so- with 84% of those interviewed admitting to such a process. Some reasons that doctors found for their patients refusing the prenatal Tdap had to do with safety concerns and not understanding the need for the vaccine, showing that we could still make great strides with effective education.

In order to increase the rate at which pregnant women receive their Tdap, it might become necessary to standardize processes to ensure that doctor’s are discussing the prenatal Tdap more with their patients, and are documenting referrals and follow-ups. It might also be important to encourage private practitioners to stock Tdap at their office in order to make it easier on their patients, who already have so much going on in their lives.

So there it is- the culmination of 6 months of research and analysis summarized in a couple short blog posts. There were more results than just what I wrote here, though they weren’t the highlight of my research. However, if you would like to read more- or if you are just looking for something to help you with your insomnia- I have included the link to my entire thesis below. As a bonus, for those of you who don’t like to read, I have also included a powerpoint slide that summarizes my findings. Enjoy!

Thesis: https://1drv.ms/w/s!Al5M_iJL5E_vs0Hp1Zk_aCiEvGlC

PowerPoint: https://1drv.ms/p/s!Al5M_iJL5E_vsRsEECsQxAlTY57z

Corrupted Blood Epidemic- A Foray into the World of Online Gaming

I want to take a moment to discuss an incident that not many outside of the world of multiplayer online role-playing games (MMORPGs) have ever heard about. If video games may not be your thing, but widespread disease is, then please sit back and enjoy the rest of this saga. It’s a good one, I promise- which is why I’m keen to write on it 13 years after its occurrence.

In 2005, a pandemic of unseen proportions affected the lives of millions and decimated the populations of large metropolises, leaving entire cities filled with the skeletons of those infected. There was no media outcry, no panic in the streets and no government intervention. To be fair though, the lack of public health intervention likely had something to do with the fact that the entire outbreak happened within the virtual realm of World of Warcraft (WoW). World of Warcraft is a multiplayer online role-playing games and today boasts over 6 million players. Within WoW, players can create their own unique characters (known colloquially as “toons”) and spend their time questing, working, mining, fishing, exploring, raise pets, as well as performing many other activities that the world has to offer. WoW even has its own complicated monetary system that has been studied extensively by many economists. Ultimately, this virtual world looks and acts just like the real world, even as it remains firmly situated online.

One year after its official release, developers pushed an update to the game that spawned the existence of a boss battle with a monster named “Hakkar the Soulflayer.” This monster was a tough battle to beat, and his attacks were devastating. The game was designed so that higher level toons would need to partner up with others in order to defeat Hakkar. In many cases, toons would often find themselves outmanned, which would lead them to teleport to safe cities away from the fight in order to save themselves. One of Hakkar’s main fighting tactics was an ability known as “Corrupted Blood,” which slowly drained the character of health points. Not only did this attack drain the character’s health points, it would also spread any nearby toons and their pets. With this ability, Hakkar was able to use a single attack to harm the entire faction of toons who may have teamed up to fight against him.

This led to an inadvertent game glitch.

When developers created Hakkar and his Corrupted Blood attack, it never occurred to them that infected toons would leave the battle in search of safety. Because of this, no code was ever developed that isolated the effects of Corrupted Blood to Hakkar’s domain. As legions of toons sought to escape the devastation of Hakkar’s attacks, many of them carried the status ailment of Corrupted Blood with them to the towns that they teleported to. The infection quickly spread throughout the crowded cities. Lower level toons were automatically killed by the infection, while higher level toons were impacted by the ailment and able to then infect any other nearby toons. Eventually, the toons who were able to survive the status ailments for a set duration of time recovered naturally. The infection even spread it to non-playable characters (NPCs) that had been programmed into the game for quest-giving or shopping purposes. These characters, however, were asymptomatic and were capable of passing along the disease without being affected by its symptoms. This only helped to spread the disease even further. Within a day, the disease had reached almost every large city within World of Warcraft and left millions dead in its wake. While death in World of Warcraft is not permanent, it does carry with it some consequences and can be inconvenient for many players.

What made this virtual pandemic so notable was the human response to the event. Game creators and players’ response very much resembled the way people have historically responded to pandemics, and it is these responses that are so difficult to account for in mathematical models of pandemics. Normal game play was completely disrupted. Characters who were capable of healing others spent their time focusing on healing the infected. Lower level toons who could not heal were often found directing travelers from infected zones. Many characters sought to escape large population centers and traveled to smaller, un-infected zones. In some cases, these areas then became infection zones. There were also populations of “terrorists”- those who sought to intentionally spread the infection from themselves to others. This is likened to the true scenarios of HIV infected people who knowingly transmit the disease from themselves to others.

Blizzard imposed a voluntary quarantine of infected zones in order to stop the spread, but many within the game disregarded the request. In many cases, infected characters continued to perform jobs, regardless of their risk of spreading the disease, mirroring the way people in the real world might still go to work with the flu. Those characters who focused on healing infected members would often become infected with the disease themselves, a trend we saw with the West Africa Ebola outbreak of 2015. Another factor that caused the spread of the disease was the “rubber neck” syndrome of other players. In some cases, users would log on just to see the mayhem that was occurring throughout the virtual world, and would then become infected themselves. Before long, the cities were filled with skeletons and left abandoned as players evacuated to safer areas in the countryside. Finally, game developers were forced to shut down and reset the servers in order to stem the wave of infection, leaving the virtual world as if the pandemic had never happened.

It wasn’t until a couple of years later that epidemiologists began to look at the Corrupted Blood incident as a model to study for how people react to pandemics. Though WoW exists in a virtual world, the characters within it treated the pandemic as if it were a real threat to them- and in a sense it was. It was because of the Corrupted Blood incident that researchers began to see the potential in virtual worlds for modeling real worlds. As human behavior is often unpredictable, mathematical simulations can only do so much. Appropriate future exploitation of the “reality” of MMORPGs may yield some truly illuminating data and information on better ways to implement quarantines and prevent disease transmission on future pandemics. Utilizing the online gaming systems allows for us to not only watch the spread of a disease in real-time, but to also monitor the human responses to disasters.

Prenatal TDap Vaccination: Preventing Whooping Cough in Infants- A Thesis (Part 1)

Well, after 10 painstaking long years of school, maintaining a full time job while attending part time, I’ve finally managed to achieve a Master’s in Public Health.

I’ve written many a research paper, some that will be published here… but none so in depth as my final thesis, simply titled “Prenatal Tetanus Diptheria, and Acelullar Pertussis Vaccination Rates in Kern County, California.”

Sounds like a real bore, doesn’t it? Well, if you have no interest in the wonder of vaccinations and their ability to prevent unnecessary death, then you would be right.

I’ll post my introduction below, but for those of you still reading, let me explain the purpose for this research and what it entailed.

California has a whooping cough problem. About every 4 or 5 years, the state endures a sweeping epidemic of the disease. For most people, whooping cough is an annoyance at worst, creating a persistent cough and just a few days of fever. For the very young, those too young to be vaccinated incidentally, an exposure to whooping cough can mean death.

The thing is, we have recommendations in place to prevent infants from contracting whooping cough. A double barrier system has been developed that involves vaccination of all family members as well as a third trimester vaccination for the expectant mother. On the one hand, family vaccinations will lower the incidence of the infant coming into contact with the bacteria, while the pregnant mother’s vaccination while will promote the passive transfer of antibodies to the developing child.

In Kern County, CA- there seems to be a disconnect when it comes to receiving the all important prenatal vaccination. And while recent research has pointed to the fact that full family vaccinations are becoming unfeasible, and in some cases inefficient, prenatal vaccinations are more important than ever.

Yet only 39% of pregnant women are receiving their prenatal vaccinations in Kern County, CA.

What is going on here? Why are prenatal vaccination rates so low? And what can we do to improve those rates? These are the questions my thesis sought to answer by traveling all across the county and looking at the processes OB/GYNs have in place to help them ensure their patients obtain their vaccinations.

I’ll copy/paste the introduction to my thesis below, but you’ll have to wait a bit for my results follow-up blog post. In the meantime, I hope this gets you thinking about the importance of prenatal vaccinations.

Prenatal Tetanus, Diphtheria, and Acellular Pertussis Vaccination Rates
In Kern County, California

INTRODUCTION

In 2016, Kern County, CA saw the death of an infant due to the preventable disease pertussis (Long, 2012). The child, who was less than 6 months old at the time of death, was at an
age that is most vulnerable and least protected from the disease. Just six years prior to this death, California saw an outbreak of pertussis sweep across the state, infecting over 9,000 people while hospitalizing 800 (Long, 2012). During this epidemic, the infection and subsequent complications took the lives of 10 infants (Long, 2012).

Infants remain one of the most vulnerable populations to pertussis outbreaks due to their still developing immune systems and their inability to receive the pertussis vaccination until they are 8 weeks old (Kharbanda, et al, 2016). To protect infant lives, the Centers for Disease Control
and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) have enacted recommendations for women in their third trimester to receive the tetanus,
diphtheria, and acellular pertussis (Tdap) vaccine so that they may prevent spreading the disease to their newborn while also creating passive immunity for the fetus (CDPH, 2016).

Even though the recommendations for prenatal pertussis vaccinations are widespread and well-known, the state of California has been unable to achieve a vaccination rate of even half of the population of prenatal patients (CDPH, 2016). Kern County, specifically, has one of the lowest rates of prenatal Tdap vaccinations in the state (CDPH, 2016). The purpose of this research is to identify some of the possible reasons for the low rate of prenatal vaccinations within Kern County, CA. This research also seeks to understand any barriers that pregnant women may have in receiving their pertussis vaccination in a timely manner.

Disease Description

Bordetella pertussis is an infectious gram-negative bacterium known for causing the disease pertussis, better known as whooping cough. It is a toxin producer, and promotes disease
in individuals by attaching itself to the cilia of the respiratory epithelial cells and paralyzing the cilia. This causes inflammation of the respiratory tract to occur, which then interferes with
pulmonary secretions from getting cleared. This creates cold-like symptoms approximately 7-10
days after the original exposure; though the first symptoms have been known to form up to 21 days after first exposure.

The first stage of symptoms, known as the catarrhal stage, includes
sneezing, a runny nose, a low-grade fever and an occasional cough. After 1 to 2 weeks of this, the second stage, known as the paroxysmal stage, begins. (Centers for Disease Control and
Prevention, 2015). Pertussis is not suspected until the paroxysmal stage of the disease begins. It is at this
stage where the coughing becomes much more rapid and excessive in number. This coughing is
often accompanied by a high pitch whoop, explaining the name whooping cough. Between
coughing attacks, the patients often have no other symptoms and appear to be perfectly healthy.
During attacks, however, patients may begin to turn blue or become cyanotic. This stage of the disease is especially serious for infants and young children, who will become very ill and appear
distressed. The paroxysmal stage usually lasts between 1 and 6 weeks, but has been known to last up to 10 weeks. (Centers for Disease Control and Prevention, 2015).

The final stage of the disease, known as the convalescent stage, is often the same as the recovery stage. During this time, approximately 2-3 weeks, the cough begins to go away and
occur less over time. If a patient contracts only pertussis during this time, the cough will completely disappear by the end of this stage. It is only in those who have complications and subsequent respiratory infections that will often experience the paroxysmal cough for months
after the initial onset. (Centers for Disease Control and Prevention, 2015).
Pertussis can be an incredibly contagious disease. Its basic reproductive number (R0) is at
a rate of 12 to 17, meaning that each person who becomes infected with whooping cough will then pass that infection to no less than 12 to 17 other people (Clark, Messonnier, and Hadler,2012). Vaccination against the disease is really the only mode of defense against the infection.

Infants remain the most vulnerable population simply because they cannot be vaccinated until 8 weeks at the earliest, and even then, do not boast complete immunity until about a year of age (CDPH, 2016). When it comes to protecting infants, research has proven that one of the most effective ways to prevent transmission is the process of cocooning (the act of inoculating those
who encounter the infant) together with a prenatal Tdap administered to expectant mothers between 27 and 36 weeks of pregnancy with each pregnancy, regardless of past immunizations (Peters, et al, 2012; CDPH, 2016).

Kern County, California

Kern County, California is a county located north of Los Angeles County with a land area of approximately 8,132 square miles. It contains a moderate population of over 880,000 people.
Of the entire county’s population, 42% live within the boundaries of what is probably considered the only city in the county: Bakersfield, CA. Outside of Bakersfield, the county is made up of
small townships and unincorporated areas. Kern County also boasts the presence of Edwards Air Force Base, as well as many agricultural and oil drilling areas (U.S. Census Bureau, 2017). Pertussis is endemic to Kern County and often cycles through

epidemics every 3-5 years.
By tracking the last few years of pertussis incidences, data shows that the highest incidence of disease often occur in the spring and summer months (CalREDIE, 2017). The most recent epidemic in Kern County occurred in 2014, and lasted months into 2015. Most outbreaks in Kern
County have been shown to occur in the spring and fall months.

On average, Kern County has a population of 100.3 people per each square mile. A little over 34.8% of the population claims white (not Hispanic), and 52.8% of the population claims Hispanic. Over 22% of the county lives in poverty and the median household income is just under $50,000 a year. In comparison, the whole of California has a poverty rate of 14.3% and a median house income of over $63,000— placing Kern County below the state average. (U.S. Census Bureau, 2017).

Kern County, CA has one of the lowest rates of prenatal Tdap— with just 39% of expectant mother receiving the vaccination (CDPH, 2014; CDPH, 2016). This makes Kern County the fourth lowest county for receiving prenatal Tdap vaccinations (CDPH, 2016). In comparison, many of the northern counties, such as San Francisco and Santa Clara, maintain prenatal vaccination rates of almost eighty percent (CDPH, 2016). California, on average, has close to a 50% prenatal vaccination rate (CDPH, 2016). The rate of prenatal Tdap vaccinations in
Kern County is lower than the state rate, even as pertussis epidemics remain cyclically endemic
to the location. The preventable death of even one infant in Kern County is reason enough to try and determine why the prenatal vaccination rates are so low to develop ways in which we can
improve these rates.

This research seeks to uncover reasons why only 39% of Kern County’s expectant mothers are receiving the prenatal Tdap vaccination. This study will outline the background of pertussis in California as well as past vaccination recommendations that have been in place to promote infant protection against pertussis. It will also review the current data and trends regarding pertussis vaccination and incidence of disease in Kern County versus the state to provide context for the research. A study of Kern County’s prenatal care providers will assist in determining what interventions may be necessary to improve the prenatal Tdap vaccination rates.

25 Critical Facts About Ebola- A rebuttal for Fear Mongering Propaganda

In response to the following article:

http://www.americasfreedomfighters.com/2014/08/03/25-critical-facts-about-the-ebola-outbreak-that-every-american-should-know/

I wrote the following in order to try and remove some of the fear-mongering about EBV. To be clear, it is still a dangerous and tragic disease, but the propaganda that is being sent out is only going to lead to hysteria. 

 Sorry for any typos… took me a few hours to write up…. 

#1 As the chart below demonstrates, the spread of Ebola is starting to become exponential…

                This is a normal occurrence for any outbreak…. The disease will peak at some point before it starts to drop off. This is called the epidemic curve. This is nothing different from any other outbreak in the history of outbreaks.

#2 This is already the worst Ebola outbreak in recorded history by far.

                This is absolutely right. It is a scary disease, and part of the reason why it’s so largely out of control is because of the location of its outbreak. This is the first time Ebola has shown up in West Africa. West Africa is a lot more densely populated than some of the tribal areas it has hit in the past. So, therefore, there are a lot more people to infect. It’s believed to have found its way to West Africa in part to deforestation.

#3 The head of the World Health Organization says that this outbreak “is moving faster than our efforts to control it“.

                This is also true. Take a look at West Africa. They have a developing country infrastructure as well as limited health care workers to help. The people there are terrified of the health care workers and are hiding from them. Many of them are leaving dead bodies where they lie, and if they don’t leave them they are burying and cleaning the family members themselves. As you probably know, (or don’t), the bodies are still contagious after death. They aren’t reporting the outbreaks that do happen because they are afraid of being taken away from their family members. The sick are being housed in little more than shacks with many people to one room. On top of that, the fruit bats (which are considered carriers) are often a cheap and normal staple of their diet, which is only helping to further spread the disease.  

#4 The head of Doctors Without Borders says that this outbreak is “out of control“.

                This is repetitive. See statement 3.

#5 So far, more than 100 health workers that were on the front lines fighting the virus have ended up contracting Ebola themselves.  This is happening despite the fact that they go to extraordinary lengths to keep from getting the disease.

                This is true as well. When an Ebola outbreak happens, and this has been the case for every outbreak since it was discovered in the 70’s, the most commonly infected are family members and health care workers. They do go to great lengths to defend themselves against the disease, however, the resources are limited. The most they can do is create what are known as clothing barriers… which are basically gloves, face masks, eye protection and gown. However, again, the situation is less than ideal in Africa. You ever try getting completely clean while camping? Imagine it’s like that except you’re trying to prevent a nanometer of virus from landing on you.

#6 There is no cure for Ebola.

                This is also true. There is no cure for Ebola. However, in the US we have given the ebola-infected doctors an experimental drug. Also, there is a talk of a vaccine being released next year. *Fingers Crossed*

#7 The death rate for this current Ebola outbreak is over 50 percent, and experts say that it can kill “up to 90% of those infected“.

                The death rate of this EBV (Ebola Virus) outbreak is right at 60%. The strain that this particular EBV comes from is known as the Zaire strain which had a death rate of 90%. This is the bad kind of EBV… and this outbreak is a pretty scary one.

#8 The incubation rate for Ebola ranges from two days to 21 days.  Therefore, someone can be carrying it around for up to three weeks without even knowing it.

                This is true as well, however, it only becomes contagious once symptoms start to show.

#9 For the first time ever, human Ebola patients are being brought to the United States.  And as Paul Craig Roberts so aptly put it the other day, all it would take is “one cough, one sneeze, one drop of saliva, and the virus is loose“.

                And no, it doesn’t take one cough or one sneeze. Barely even a drop of Saliva. It is mostly present in the bodily wastes and blood. Luckily, these doctors have been brought to the hospital that is the most capable of caring for this level of virus. They have rooms made for this, and they are completely cut off from anyone else. The levels of protection found in the US against spreading the virus are much better than the best levels you could find in West Africa. Since returning home, one doctor is already showing signs of improvement.

#10 This has already potentially happened in the United Kingdom.  A woman reportedly collapsed and later died on Saturday after she got off of a flight from Sierra Leone at Gatwick Airport.

                This is a no. The woman was tested for, and did not, have Ebola.

#11 A study conducted in 2012 proved that Ebola could be transmitted between pigs and monkeys that were in separate cages and that never made physical contact.

                Not pigs, just monkeys. It was Reston EBV. That was only one particular strain that was discovered to be an airborne strain. This particular strain, however, did not affect humans, only the monkeys. It has been postulated that one of the human strains could one day become airborne… and that is true. In 1918, the flu swept through and killed more people worldwide in one year than WWI did in its entirety. General consensus is that we need to worry about the next flu pandemic before we really start to panic over Ebola.

#12 This is a new strain of Ebola, so what we know about other strains of Ebola may not necessarily apply to this strain of Ebola.

                Except that there are NUMEROUS strains of EBV, one of them being the Reston Strain I mentioned earlier. The only difference between any of them is the death rate. Also, this strain is VERY close to the Zaire strain…. And like I mentioned, the Zaire strain kills 90% of the people it infects. So, if anything, this particular strain is only weaker than the Zaire strain.

#13 Barack Obama has just signed an executive order that gives the federal government the power to apprehend and detain Americans that show symptoms of “diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled.”

                This is actually pretty redundant… the CDC already has what’s known as the “National Quarantine Act.” This essentially is the same thing. CDC can take federal control of quarantine. And if an outbreak were to happen, how do you think we’d contain it? If someone really had Ebola in the US, do you think they should be allowed to run around infecting other people? This is another reason why an outbreak would be unlikely to happen here. That’s also why we have a list of “reportable disease in the US,” to help epidemiologists here have an easier time tracking diseases that could potentially cause outbrea’ks.

#14 And as I noted the other day, federal law already permits “the apprehension and examination of any individual reasonably believed to be infected with a communicable disease”.

                See above. Quarantine laws. They are necessary to prevent outbreaks, which is what this whole article is freaking out about anyway. Seriously, this guy is panicking about an Ebola pandemic, but then complains about quarantine measures?

#15 According to the CDC, there are 20 quarantine centers around the country that are prepared to potentially receive Ebola patients…

                Well, yeah… again I ask…. How do you think you stop an outbreak? These quarantine stations have been used to treat all sorts of communicable diseases. The last time that quarantine was used on a large scale, however, was during the 1918 flu pandemic. Which, did I mention millions died?

#16 The CDC has set up an Ebola “quarantine station” at LAX in order to help prevent the spread of the virus.

                Again… precautions. I suppose if no precautions were made at all this author would complain about how our administration was doing nothing to prevent an outbreak. The precautions are being made to MAKE SURE it doesn’t get into the US. And it’s because of precautions like this that, again, an outbreak is very unlikely here.

#17 The largest health emergency drill in New York City history was conducted on Friday.

                And? It was a biological attack drill. Not an “Ermahgad! Ebola is here!” drill. We have Earthquake drills in CA. We should do biological attack drills all over the country since that is still a very likely mode of attack on us. But more likely with smallpox than anything else.

#18 The federal government will begin testing an “experimental Ebola vaccine” on humans in September.

1. How do you think vaccinations get made? You make the vaccine, you do the animal trials, then you do the human trials. I fail to see how this is an argument for or against anything. By the time vaccinations get to human trials, the vaccines are pretty much safe. This is a great thing, that we have gotten to human trials. It’s a chance against any future outbreaks.

#19 We are being told that the reason why we don’t have an Ebola vaccine already is due to the hesitation of the pharmaceutical industry to invest in a disease that has “only affected people in Africa“.

                So, I had to look this one up because I had never heard I before. According to media, there is no money in an Ebola vaccine. I can believe this… seeing as how we are a country that often cuts money to education and scientific research.

                However, on top of that, Ebola is a filovirus, which is a rare family that is made of RNA instead of DNA. Because of this, there are a lot of differences in this virus (and Marburg for that matter) than other viruses that make is difficult to vaccinate again. Here is the link to a scientific paper that will explain it better:

http://jvi.asm.org/content/77/18/9733

#20 Researchers from Tulane University have been active for several years in the very same areas where this Ebola outbreak began.  One of the stated purposes of this research was to study “the future use of fever-viruses as bioweapons“.

                This is paranoid conjecture, and I can’t find an actual source on it. It’s possible they were doing biowar research, but most likely defensive since it is believed that others may use Ebola against us. We are known to dabble in making bioweapons and have even used them against other countries in the past. In fact, we even had a bioweapons department for 27 years… before FDR closed it down. Whether there is still one is unknown. Ebola’s greatest weakness is the fact that is kills too quickly, which doesn’t actually make it a very good bioweapon.

However, this has nothing to do with the current outbreak.

#21 According to the Ministry of Health and Sanitation in Sierra Leone, researchers from Tulane University have been asked “to stop Ebola testing during the current Ebola outbreak“.  What in the world does that mean?

                Again, I don’t really know anything about this. But the Tulane students are currently helping with the outbreak. Not sure if this article is trying to make some sort of conspiracy theory or what… but this has nothing to do with the current outbreak, considering it moved from Guinea to Sierra Leone, not the other way around.

#22 The Navy Times says that the U.S. military has been interested in studying Ebola “as a potential biological weapon” since the 1970s…

1. Duh. Have you met our Department of Defense? That was also when Russia had a very large bioweapons department. It was like a great arms race but for viruses instead. Every country wants to have the biggest, baddest weapons

Filoviruses like Ebola have been of interest to the Pentagon since the late 1970s, mainly because Ebola and its fellow viruses have high mortality rates — in the current outbreak, roughly 60 percent to 72 percent of those who have contracted the disease have died — and its stable nature in aerosol make it attractive as a potential biological weapon.

1. Again, nothing to do with the current outbreak. This has been studied for a while now, and is nothing new. This “journalist” did not just figure this out. This has not been a secret at all. It makes an unlikely one however because of how quickly it kills and how hard it is for the terrorist to get and maintain samples of.

#23 The CDC actually owns a patent on one particular strain of the Ebola virus…

The U.S. Centers for Disease Control owns a patent on a particular strain of Ebola known as “EboBun.” It’s patent No. CA2741523A1 and it was awarded in 2010.

It is being reported that this is not the same strain that is currently being transmitted in Africa, but it is interesting to note nonetheless.  And why would the CDC want “ownership” of a strain of the Ebola virus in the first place?

                There are many different strains of Ebola (Below). EboBun is BDBV. It was discovered in Uganda. As you can see, these are all named after where they are found.

Bundibugyo ebolavirus (BDBV)

Zaire ebolavirus (EBOV)

Reston ebolavirus (RESTV)

Sudan ebolavirus (SUDV)

Taï Forest ebolavirus (TAFV).

I have no idea why the CDC patented a type. It seems odd to me, but I don’t really care. Might be because  any vaccine made from it might fall under the same patent and therefore owned by the US. It has nothing to do with the current outbreak, though.  

#24 The CDC has just put up a brand new webpage entitled “Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals“

                I don’t know how many times I have to say precautions. So. Precautions. They are prepared incase anything does happen. People own guns for self-defense, doesn’t mean they’ll ever need to use it.

#25 The World Health Organization has launched a 100 million dollar response plan to fight this Ebola outbreak.  Others don’t seem so alarmed.  For example, Barack Obama is getting ready to take a “16 day Martha’s Vineyard vacation“.

                Yes, the WORLD Health Organization, which is responsible for the public health of every country, not just the rich ones is trying to help fight EBV in West Africa because is a MAJOR public health emergency. Incidentally, the EBV outbreak which has going on since January was barely made mention in the media until the US “risked everyone” by bringing to patients to the US. And as the mantra in the US goes, “Don’t spend money elsewhere when we have our own people to worry about over here.”

I did not include any sources in this, but I am more than happy to supply them on request.

Ebola

It’s what everyone is talking about. The Ebola virus is ravaging West Africa with a fatality rate of 60% and over a thousand deaths already. It is an international, social, and public health crisis. Here in America, we talk about it with barely restrained panic, glorifying in our gruesome daydreams of the same outbreak occurring here within our borders. Many have used it as a way to blame the current government establishment, with some even going so far as to paint President Obama as a mad scientist gleefully creating the virus in a secret lab somewhere. Others have used the “luck” of having such an outbreak like this as a useful argument for tightening our immigration laws and closing our borders.
When two American doctors effectively came down with the virus and were brought home for treatment, you would have thought we had personally injected every American here with the virus. Then, there was the controversy of ZMapp, an experimental serum that magically appeared out of thin air that was given to the two stricken patients. Now, it almost looks as if we were holding out on West Africa, even though this serum had never before been tested on humans.
The level of panic, controversy and mistrust surrounding the entire outbreak is so high and muddled that many people have seen to forgotten that there are individual people dying over there, and matters are becoming harder and harder to control.

I have written an article on the panic surrounding this entire outbreak, but I will put that on a separate post to separate these two rants. This post will give the reader a much better understanding of the virus as it stands now and it’s unlikelihood of affecting the US.