Author: PLOS Medicine

The Global Response to the Ebola Fever Epidemic: What Took So Long?

Mark J. Siedner of Harvard Medical School and John D. Kraemer of the O’Neill Institute for National and Global Health Law, Georgetown University, discuss the impact of the delayed global response to the Ebola epidemic.

On August 8, twenty weeks after the first suspected cases in what has become the worst hemorrhagic fever outbreak in history, the World Health Organization’s (WHO) Director-General declared the epidemic a public health emergency of international concern (PHEIC). The announcement, which signals that an epidemic constitutes a sufficient public health risk to member WHO States through the spread of disease, will ideally motivate financial and logistic support to the countries most affected. But after nearly 1,000 deaths, and for a disease where a relatively simple and coordinated public health response has extinguished prior epidemics, many are left wondering, “what took so long?”

An integral part of the WHO mission, mandated by the International Health Regulations (IHR), is to protect member states from international public health threats. The IHR were revised in 2005 after the SARS outbreak to improve responses to epidemics in an increasingly globalized world. Among the IHR’s central components is commitment from high-income countries to build capacity to prevent public health emergencies, and to provide assistance during active ones. The IHR task WHO with promptly identifying emergencies by declaring PHEICs to sound the proverbial alarm.

Timeline demonstrating course of Ebola epidemic including cumulative suspected cases, deaths, and notable events during the period (Source: CDC).

Timeline demonstrating course of Ebola epidemic including cumulative suspected cases, deaths, and notable events during the period (Source: CDC).

By most accounts, the criteria to declare a PHEIC were met months ago (Figure 1). The outbreak quickly made public health impact with its rapid pace and case fatality rates above 50% and by disproportionately affecting healthcare workers. It became an international epidemic five days after the first cases were reported when it spread from Guinea to Liberia. The epidemic is also unusual because it represents the first hemorrhagic fever epidemic in urban areas, where poverty and population density exacerbate disease spread. Only nine days after Guinea notified the WHO of the outbreak, Senegal closed its land borders with Guinea. By the end of May – 10 weeks before the PHEIC declaration – the epidemic raged on in Guinea, gained speed in Sierra Leone, and reemerged in Liberia.
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Category: General | 4 Comments

Ebola: Liberians Destined for Extinction

Liberian medical student Gondah Lekpeh gives us his perspective from the front lines of the Ebola outbreak.

On July 22 of this year, the Liberian Minister of Health informed us and the world that the Ebola hemorrhagic fever outbreak in our country is out of control. This disease is caused by the deadly Ebola virus, and the fate of infected individuals is death in 90% of cases.

The announcement followed more than a month of efforts by the Ministry of Health to contain and eradicate the virus. The Ministry is doing what it can, but with the weak health care system because of the lack of human and other resources, the Ebola outbreak has caused the system to break down. The disease continues to directly and indirectly take away lives. Indeed, our relatives, colleagues and friends are perishing daily and our survival as a people is unpredictable. Either through natural selection some will survive, or we will all be extinct. As I was writing this, a childhood schoolmate of mine, a nurse, just died this morning after contracting the disease at St. Catholic Hospital while treating a patient about two weeks ago.

Here in Liberia, the virus is spreading like wildfire, devouring the life of everyone along its path. Limited health resources, ignorance, stigmatization, denial, and cultural burial rites are fueling the spread of the disease. Ebola cases are reported in ten of the fifteen counties in our country. I do not have the space and time to elaborate on how ignorance, denial, stigmatization as well as cultural practices are spreading the virus. But regarding limited health resources, here is the tip of the iceberg. As part of control measures, everyone was advised to call the Ebola response unit for safe transfer of suspected cases and disposal of corpses from communities in and around Monrovia. There are two ambulances to transfer suspect cases to isolation center and two burial teams for Monrovia. These teams are overwhelmed and it takes about two to three days to respond to calls from communities. The relatives of suspected cases end up transporting the patient in a commercial vehicle, thereby contaminating themselves. The remains of suspected cases who died at homes spend days before the burial team can arrive. Moreover, there is only one treatment center in Monrovia. The isolation center is full to capacity and suspected cases are reportedly turned away. When will the spread and death of Ebola stop in the wake of limited resources? I do not know. But I know for sure that contact tracing is not possible and we are overstretched and exhausted.

Besides Ebola directly killing here, others are dying of treatable conditions due to closure of health facilities. Most health facilities in and around Monrovia have been closed for the past three weeks. This followed the failure of most health workers to show up on duty after the death of their colleagues. They fled due lack of equipment as simple as gloves to protect themselves. At the beginning of this week, some of these health facilities reopened. But activities currently at these hospitals are limited to training of staff on precaution measures. I do not know the fates of those with treatable conditions other than Ebola. Where the obstetric emergency cases are being managed? Where are the hundreds of children who usually present weekly at John F. Kennedy Medical Center under-five ER with diarrhea and severe dehydration and severe malaria complicated by anemia, hypoglycemia and seizure, seeking care? I do not know. But I know there are numerous corpses in homes in and around Monrovia which have overwhelmed the burial teams.

The Ebola virus is like a merciless rebel determined to annihilate his weak and feeble enemies (Liberians). Help! Help! We are drowning in the sea of Ebola.

About the author: Gondah Lekpeh is a fourth year medical student at A.M. Dogliotti College of Medicine in Monrovia, Liberia.

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Introducing a New Look for the Journal Homepages

Today sees the launch of our re-vamped homepages for PLOS Medicine, PLOS Pathogens and PLOS Neglected Tropical Diseases. They’ve been designed to give easy access to all recently published work, and to better incorporate some of the beautiful images that accompany PLOS articles.

Take a look and see what you think:

www.plosmedicine.org

www.plospathogens.org

www.plosntds.org

 

2014-07-29 16_30_08-Medicine mock up

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The Blue Marble Health Collection: Redrawing Boundaries that Disease has Already Crossed

Peter J. Hotez, Co-Editor-in-Chief of PLOS Neglected Tropical Diseases, and Larry Peiperl, Chief Editor of PLOS Medicine, on a new PLOS Collection that highlights a shift in current thinking about global health.

This week PLOS Neglected Tropical Diseases and PLOS Medicine have joined forces to launch Blue Marble Health: the mismatch between national wealth and population health, the most recent PLOS Collection.

Two key PLOS papers, each published in the fall of 2013, stimulated the genesis of this Blue Marble Health Collection.

The poor living among the wealthy.

Major areas of poverty in the G20 nations and Nigeria, where most of the world’s NTDs occur.
doi:10.1371/journal.pntd.0002570.g001

The first, from PLOS NTDs - ”NTDs V.2.0: ‘Blue Marble Health’—Neglected Tropical Disease Control and Elimination in a Shifting Health Policy Landscape” –  found that while some NTDs such as river blindness, loiasis, African sleeping sickness and schistosomiasis are largely or exclusively diseases of sub-Saharan Africa, paradoxically many of the world’s highest concentration of NTDs occur in the 20 wealthiest economies – the group of 20 (G20) countries – especially in the mostly hidden pockets of extreme poverty that can be found in the big middle-income nations, such as Indonesia or in areas of the  BRICS countries, including northeastern Brazil, northern India, and southwestern China.  Moreover, the disease burden from NTDs is alarmingly high in the southern United States, especially in Texas and the Gulf Coast, in areas of Australia with large Aboriginal populations such as the Northern Territories, and Eastern Europe.

A parallel editorial in PLOS Medicine - Poor Health in Rich Countries: A Role for Open Access Journals - noted that relative poverty within a society is a stronger predictor of health than aggregate measures of economic power such as GNP or per-capita income. For example, tens of millions of Americans living in poverty, including many people of color, “experience levels of health that are typical of middle-income or low-income countries.” The editorial concluded that, for many issues that affect the health of people of lower socioeconomic status, clear-cut distinctions between “domestic” and “cross-border” research are becoming increasingly difficult to draw.


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Category: General, NCDs, Neglected Diseases | 1 Comment

Thanks to our peer reviewers in 2013!

As 2014 begins we’d like to thank those who made it possible for the PLOS Medicine Group journals to serve the scientific community and the public in 2013, in particular our dedicated and insightful peer reviewers.  During last year, 663 people reviewed for PLOS Medicine, 2205 for PLOS Neglected Tropical Diseases, and 3008 for PLOS Pathogens. These generous individuals donated their time to ensuring the level of constructive evaluation that researchers rightly expect of peer-reviewed journals. Their combined efforts enabled the PLOS medical journals (PLOS Medicine, PLOS NTDs and PLOS Pathogens) to publish an outstanding array of papers in 2013, gathering 4107155 online views and 501871 PDF downloads so far!

Thank you, our reviewers, for contributing your knowledge to the Open Access literature. Your critical insight, support, and hard work are indispensable both to our day-to-day operations and to our overall mission.

Image Credit: Ben Fredericson on Flickr

Image Credit: Ben Fredericson on Flickr

We’d also like to draw attention to the folks who have reviewed for the other PLOS journals:

PLOS ONE’s peer reviewers: http://blogs.plos.org/everyone/2014/01/06/thanking-peer-reviewers/

PLOS Biology, PLOS Computational Biology and PLOS Genetics peer reviewers: http://blogs.plos.org/biologue/?p=5003

Thanks again!

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This Week in PLOS Medicine: HIV Transmission during Early Infection, Impact of Police Activities on Drug Users, and Data Sharing in a Humanitarian Organization

This week PLOS Medicine publishes the following new articles:

SoM_Dec_10

Image Credit: Jonathan Gray, Wikimedia Commons

Erik Volz and colleagues use HIV genetic information from a cohort of men who have sex with men in Detroit, USA, to dissect the timing of onward transmission during HIV infection. In particular, it allowed the researchers to estimate that, in the current HIV epidemic in Detroit, 44.7% of HIV transmissions occur during the first year of infection. These findings may not be generalizable to other cities or to other risk groups. Nevertheless, the findings of this analysis have important implications for HIV control strategies based on the early treatment of newly diagnosed individuals. Because relatively few infected individuals are diagnosed during early HIV infection, when the HIV transmission rate is high, it is unlikely, suggest the researchers, that the ‘‘treatment as prevention’’ strategy will effectively control the spread of HIV unless there are very high rates of HIV testing and treatment. In a related Perspective, Tim Hallett reflects on the influence of early HIV infection on disease epidemic dynamics.
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This Week in PLOS Medicine: HIV Transmission during Early Infection, Impact of Police Activities on Drug Users, and Data Sharing in a Humanitarian Organization

This week PLOS Medicine publishes the following new articles:

SoM_Dec_10

Image Credit: Jonathan Gray, Wikimedia Commons

Erik Volz and colleagues use HIV genetic information from a cohort of men who have sex with men in Detroit, USA, to dissect the timing of onward transmission during HIV infection. In particular, it allowed the researchers to estimate that, in the current HIV epidemic in Detroit, 44.7% of HIV transmissions occur during the first year of infection. These findings may not be generalizable to other cities or to other risk groups. Nevertheless, the findings of this analysis have important implications for HIV control strategies based on the early treatment of newly diagnosed individuals. Because relatively few infected individuals are diagnosed during early HIV infection, when the HIV transmission rate is high, it is unlikely, suggest the researchers, that the ‘‘treatment as prevention’’ strategy will effectively control the spread of HIV unless there are very high rates of HIV testing and treatment. In a related Perspective, Tim Hallett reflects on the influence of early HIV infection on disease epidemic dynamics.
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This Week in PLOS Medicine: Insufficient Antimalarial Dosing in Children, Completeness of Trial Reporting, and Increases in Journal Retractions

This week PLOS Medicine publishes the following new articles:

Image credit: Karunakar Rayker, Flickr

Antimalarial drug resistance has hampered malaria control programs for almost 60 years. A key factor in combating this threat is to ensure that all antimalarial drugs are deployed in a way that ensures that the maximum number of patients are completely cured. Ric Price and colleagues pool individual patient data from efficacy trials coordinated by the WorldWide Antimalarial Resistance Network (WWARN). The results show that, while treatment of malaria with dihydroartemisinin-piperaquine generally results in excellent patient recovery, young children are at higher risk of treatment failure and this may be due to their receiving an insufficient dose of the drug. The study also highlights that one third of children aged 1–5 years received a dose of piperaquine below that recommended by the World Health Organisation. Furthermore, patients receiving a lower dose were slower to respond to treatment and had a greater risk of getting malaria again. In a linked Perspective, Paul Garner further discusses dosing issues for artemisinin combination therapy.
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This Week in PLOS Medicine: Insufficient Antimalarial Dosing in Children, Completeness of Trial Reporting, and Increases in Journal Retractions

This week PLOS Medicine publishes the following new articles:

Image credit: Karunakar Rayker, Flickr

Antimalarial drug resistance has hampered malaria control programs for almost 60 years. A key factor in combating this threat is to ensure that all antimalarial drugs are deployed in a way that ensures that the maximum number of patients are completely cured. Ric Price and colleagues pool individual patient data from efficacy trials coordinated by the WorldWide Antimalarial Resistance Network (WWARN). The results show that, while treatment of malaria with dihydroartemisinin-piperaquine generally results in excellent patient recovery, young children are at higher risk of treatment failure and this may be due to their receiving an insufficient dose of the drug. The study also highlights that one third of children aged 1–5 years received a dose of piperaquine below that recommended by the World Health Organisation. Furthermore, patients receiving a lower dose were slower to respond to treatment and had a greater risk of getting malaria again. In a linked Perspective, Paul Garner further discusses dosing issues for artemisinin combination therapy.
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This Week in PLOS Medicine: Maternal Health Collection, Pharmaceutical Industry, Burden of the 2009 Influenza Pandemic, & Poverty and HIV Stigma

This week PLOS Medicine publishes the following new articles:

Image credit: Jack Zalium, Flickr

The Maternal Health Task Force (MHTF) and PLOS Medicine issue the call for papers for Year 3 of the MHTF-PLOS Collection: Integrating Health Care to Meet the Needs of the Mother–Infant Pair. The MHTF-PLOS collaboration is looking for research and commentary papers that fit the theme. All papers should be submitted to PLOS Medicine, with a clear statement in the cover letter that they are intending to submit to the MHTF-PLOS Collection.

In a systematic review of 15 studies of interactions between non-physician clinicians and industry, Quinn Grundy and colleagues found that many of the issues identified for physicians’ industry interactions exist for non-physician clinicians (Registered Nurses, advanced practice nurses with prescriptive authority, physicians’ assistants, pharmacists, dieticians, and physical or occupational therapists). Most non-physician clinicians across disciplines held favorable views of interactions with sales representatives and industry interactions in general. A minority perceived that industry marketing influenced their own practice, but more felt their colleagues would be influenced. Preparation for industry interactions generally was not a part of professional training.  In a related Perspective, James Yeh and Aaron Kesselheim discuss the steps needed to address the conflicts of interest posed by contact between non-physician providers and the medical products industry. They suggest that because current programs intended to provide transparency about the prevalence of pharmaceutical industry marketing may not reach the non-physician clinician population, institutional policies should be constructed to apply to all providers of patient care.
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