Symposium Examines Global Emerging Infections, Response

by Loumarie I. Rodriguez

SOUTHBURY — A symposium on Global Emerging Infections and Local Response offered insight and a critique on the handling of the Ebola outbreak and the importance of sharing proper information in light of the Zika virus.

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Dr. Lisa Dunkle, MD, chief medical officer at Protein Science Corp., in Meridan spoke to a pack room regarding the company’s work in creating vaccines. Photo Credit- Loumarie I Rodriguez

The Pomperaug Health District Medical Reserve Corps sponsored the symposium on Monday, April 11, at the Pomperaug Woods Retirement Community.

Neal Lustig, PHD director of health, introduced symposium speakers and explained the Reserve Corps’ responsibility to the community.

The Reserve Corp enforces public health regulations and fulfills the main functions of public health and essential services such as administering various vaccines.

Symposium speakers included James Handler, M.D., an epidemiology consultant to Yale University’s emerging infections programs and the New York City Department of Health and Mental Hygiene.

He is the former epidemiologist and director of infectious diseases at the state Department of Public Health.

Ellen Neuhaus, M.D., is an epidemiologist and infectious disease physician at the Rockville General Hospital in Vernon.

Lisa Dunkle, M.D., is the chief medical officer at Protein Sciences Corp., based in Meriden with two other locations in Pearl River, N.Y., and Gifu, Japan.

The symposium focused on the latest research, procedures and discoveries on emerging infections across the globe. Each speaker stressed the importance of proper information regarding current infections gaining traction, including Zika.

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Photo Credit- National Cancer Institute of Colombia

Dr. Hadler focused his presentation on the response to the Ebola epidemic and what was learned during that time and how to be prepared for Zika.

He was critical of the response to the Ebola outbreak, including Yale’s response to graduate students returning from Liberia in October 2014.

He noted the term “emerging infections” was first coined by the Institute of Medicine in a report published in 1992. The IOM reported emerging infections as new, re-emerging or drug resistant infections that exhibited the threat to increase in the near future.

Emerging infections were revisited by the Center for Disease Control and Prevention in 2003, which added an aging population and changing ecosystems as contributing factors in emerging infections.

Dr. Hadler said that in July 2014, when the Ebola epidemic began to catch global attention, the CDC began to send out a series of alerts to health departments and hospitals. He noted one particular alert that focused on anti-stigmatism.

The alert, sent on August 21, 2014, urged health officials to combat stigmatism and discrimination towards people from and of West African descent. Dr. Hadler said the alert was never repeated or enforced.

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Photo Credit- James Cooper, Sunday Bondo and Patrick Lappaya take sample swabs. 

Due to escalation of the events following the first few alerts and public awareness of the Ebola outbreak, the response to potential threats of the virus began to turn ugly and discriminatory, according to Dr. Hadler.

In September 2014, airports in affected countries began screening people exiting the country to go to the U.S.

He cited the two Yale University Ph.D. students who returned from Liberia on October 11, 2014, after studying Ebola, but not with Ebola patients.

They were told to voluntarily stay away from campus. He said the university missed the opportunity to educate faculty and staff.

Connecticut ordered strict quarantine for the students after one student went to the hospital and tested negative for the Ebola virus. Dr. Hadler said the response did not make any sense.

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Photo Credit- National Cancer Institute of Colombia

“An evolving situation requires an evolving response,” said Dr. Hadler. “That evolving response did happen in the United States and it got ratcheted it up as concern grew. But that response should be scaled back as the situation gets under control.”

Dr. Neuhaus said a hospital’s job is to make sure bacteria does not get into the hospital population.

Dr. Neuhaus said it was imperative all staff were well-educated on the disease and how to prepare themselves when taking care of a patient. Information sessions taught staff how to put on and take off the proper protective garb.

She sent out frequent updates to local and private physicians asking that potential Ebola patients not be sent to the emergency room until the hospital was prepared to take them. It took both hospitals and ambulances several hours to prepare for potential Ebola patients.

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Photo Credit- Liberia post on Ebola

Dr. Hadler said the state needs to review its quarantine plans and make sure the quarantine definition is functional and done in the least restricted way.

“So I think we need to plan on a stronger health educational response,” said Dr. Hadler. “If the situation arises, the respond to each situation of stigma or unnecessary exclusion.”

Dr. Hadler added that the Ebola panic illustrated what happens when public health efforts loses creditability as was seen in October 2014 when politics and panic took over.

He pointed out the Chikungunya virus began to spread rapidly the year before the Zika virus was. Chikungunya is not native to the Americas. The transmission is only occurring from humans to mosquitos to humans.

Chikungunya causes fever, rash, fatigue, joint pain and nausea, which is similar to the Zika virus. The differences are Chikungunya is more severe and can cause chronic joint pain.

Zika is also a mosquito-borne virus, in the same group as the West Nile virus. Currently, Puerto Rico is bracing for a potential Zika epidemic as summer arrives.

Dr. Hadler’s assessment of the Zika virus is that there is a small potential for transmission, but public health officials need to remember that the virus can adapt to the mosquito causing local transmission.

Roughly 80 percent of those who contract the Zika virus report no symptoms. The illness is very mild. A rash and a low-grade fever are the common symptoms.

The Zika virus can be passed from a pregnant woman to her fetus and can cause serious birth defects as confirmed by the CDC. Dr. Hadler said the highest risk is within the first trimester.

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Photo Credit- Larval Aegypti Mosquitos

There needs to be more sophisticated testing for the Zika virus by the CDC, according to Dr. Hadler.

He concluded, the CDC and departments of health need to maintain a consistent risk and travel advisory.

Dr. Neuhaus’ main message to the public is not to panic about the Zika virus. She said she will be traveling to the Dominican Republic and has prepared by packing DEET bug spray.

She compared the Zika virus scare to the attitude when HIV and AIDS first became public. She said one day the public will find rational decision making.

“Our concerns at the hospital level are very different than the public health’s concerns,” said Dr. Neuhaus.

She said her job is to keep staff and patients safe from transmission and passage of diseases. The Zika virus is not a major concern for her at the hospital.

Her main worry is bacteria found globally. She said there are outbreaks of mumps, especially on college campuses, that are more of a concern because patients need to be isolated. Mumps is highly contagious.

Her conclusion was that a hospital’s main concern is resistant bacteria that can be exposed to the general hospital population. She said bacteria exposure can create much more chaos than an Ebola outbreak.

Dr. Dunkle noted that the Zika virus is very new and a lot of new data is still being introduced. She said there are many hurdles to creating a Zika vaccine including, no standardized tests for human diagnosis and no established path to regulatory approval.

Dr. Dunkle reminded there is no immediate funding for the development of a vaccine.

Her facility, Protein Sciences Corp. in Meriden, uses the Baculorvirus Expression Vector System to produce vaccines. The system uses recombinant DNA technology to produce the antigen that will induce immunity.

Dr. Dunkle said Protein Sciences Corp.’s modern approach to vaccines involves cloning eggs that are used for the current influenza vaccine.

Traditional methods for influenza vaccines required growing eggs. One egg equals one dose with about 130-150 million doses manufactured.

“Our facilities are licensed to produce multiple projects and products, so we can do a Zika vaccine,” said Dr. Dunkle. “Our technology is now developing a Zika vaccine.

“We believe the availability of a protective Zika vaccine depends on funding and regulatory collaboration.”

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