APHL’s Top 10 Blog Posts of 2014

Dec 18 2014 :: Published in General

Wow, this has been quite a year for public health. Vaccine preventable disease outbreaks, MERS-CoV, chikungunya, EV-D68, and Ebola on top of the usual critical food safety, environmental health, preparedness and global health work being done by our members tested every system across the board. While I feel it is safe to say that no one wanted to face these issues for a multitude of reasons, we were beyond pleased to see public health laboratories face and respond to the many challenges of the year. As we hear from our members often, “It’s all in a day’s work.”

These are the blog posts that brought in the highest number of readers this year. Thank you to the APHL staff and members who wrote and contributed to these stories; and thank you to the many readers who keep coming back.

APHL's Top 10 Blog Posts of 2014 | www.aphlblog.org10. Safe Drinking Water Act has Been Protecting You for 40 Years – This year was the 40th anniversary of the Safe Drinking Water Act, the first national standard for public drinking water protections. Raise a glass of clean water with us! Cheers!

9. Where are They Now? APHL/CDC Emerging Infectious Disease Fellow Looks Back – Kayleigh Jennings, a former APHL/CDC Emerging Infectious Disease Fellow, shares some of the highlights of her fellowship experience. “I never would have had any of these life-changing experiences if not for this fellowship.”

8. MERS-CoV: Why We Are Not Panicking – Following the confirmation of two MERS-CoV cases in the US, the public began to worry that the outbreak could spread here. Some of APHL’s Infectious Disease program staff and Public Health Preparedness and Response program staff explained why they weren’t panicking. As they say in this blog post, “…We in the public health system are poised to handle MERS-CoV and other health threats whenever, wherever and however they enter our country.”

7. Could funding cuts to food safety programs make you sick? – We followed the journey of a hypothetical batch of peanuts from farm to table, so to speak. Along the way our peanuts became contaminated with Salmonella. But as funding cuts have deeply impacted food safety programs, would the contamination be detected early enough to prevent an outbreak? Or at least to stop an outbreak from spreading further?

6. USAMRIID: Biodefense from the Cold War to Present Day – Our Public Health Preparedness and Response program staff visited the US Army Medical Research Institute of Infectious Diseases (USAMRIID) and shared some of what they learned about its history and the fascinating work done in their laboratories. At the time, we didn’t know that USAMRIID would be thrown into the public eye as the Ebola story unfolded.

5. Dylan Coleman Has a Story to Warm Your Heart – Thanks to newborn screening, Dylan Coleman had a simple non-invasive test that detected critical congenital heart disease (CCHD). Without this test, Dylan may not have survived. He was the first baby born in Maryland to be diagnosed with a heart defect as a result of this newly added test.

4. In US, Massive Effort to Detect and Respond to Ebola Already Underway – Just a few weeks before the first Ebola case was identified in the US, this blog post outlined how public health laboratories were preparing just in case. By the end of the month we all learned that this preparedness effort would be tested and ultimately shown to be successful.

3. Food Safety Funding Cuts in Action – Two days after our blog post on food safety funding cuts (see #7 above) went live, it became obvious that our hypothetical situation was playing out in real life with a stone-fruit recall. Testing performed in Australia found Listeria on stone fruit distributed from a company in California. A similar program in the US was cut from the budget on December 31, 2012; had this program still been in place, the contaminated fruit may have been identified and intercepted long before arriving in Australia.

2. Enterovirus D68 Testing, Surveillance and Prevention: What We’re Telling Our Friends – As there were more and more reports of Enterovirus D68 infections in kids, parents started to worry. APHL’s Infectious Disease program staff tried to address concerns and assure people that the clinical and public health communities could handle this outbreak.

The most read blog post for 2014…

1. Testing for MERS-CoV: The Indiana Lab’s Story – The staff at the Indiana State Department of Health Laboratories were kind enough to write about their encounter with MERS-CoV. They were the first laboratory in the US to have a positive MERS case. Thanks to effective preparedness efforts and highly qualified staff, they were able to quickly and safely obtain accurate results. This is public health!

 

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TIME’s 2014 Person of the Year: Recognizing the Ebola Fighting Laboratorians

Dec 12 2014 :: Published in Public Health Preparedness & Response

By Chris N. Mangal, MPH, director, Public Health Preparedness and Response, APHL

TIME's 2014 Person of the Year: Recognizing the Ebola Fighting Laboratorians  | www.aphlblog.orgThis year saw the deadliest outbreak of Ebola in West Africa, specifically in Sierra Leone, Liberia and Guinea. The West African people, their governments and numerous international organizations have been on the frontline fighting to contain this outbreak and stop the transmission chain. We agree with TIME magazine’s choice to name The Ebola Fighters as their Person of the Year. The many doctors, nurses, ambulance drivers, researchers, volunteers, survivors and so many others who continue to work tirelessly to heal the sick, protect the healthy and contain this outbreak deserve the world’s applause. Of course, we at APHL especially want to recognize the laboratorians who are a vital part of these Ebola response teams at home and abroad. They work diligently to process thousands of samples and quickly determine whether or not an individual is infected with the deadly virus, utilizing safe laboratory practices to do so.

While domestically the public health laboratories authorized to perform the Ebola detection test have continued to state this is all in a day’s work for them, the significance of this test does not go unnoticed. As samples from suspect cases are rushed to public health laboratories, ample precautions have been taken to protect and reassure those outside of the laboratory of their continued safety. Tests are performed quickly and carefully to ensure the fastest possible turn-around and accurate results. Those results help doctors and other medical professionals determine the next steps in patient care; help researchers to develop targeted countermeasures such as vaccines and antiviral medications; and if positive, allow epidemiologists to begin contact tracing to contain the spread or, if negative, offer assurance to the public that the suspect case is negative. Thanks to swift testing in West Africa and in the US, we have seen many patients recover after early and appropriate treatment – in fact, many health professionals are now referring to Ebola Virus Disease as treatable.

Public health laboratorians join the long list of Ebola fighters worthy of being called Person of the Year. They have not turned away from their responsibility of protecting the population. The Ebola fighters will likely not rest over the holidays – they will continue to battle Ebola and protect the public’s health. For that, we are grateful.

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Say “Thank You, Public Health!”

Nov 20 2014 :: Published in General, Partners

Say "Thank You, Public Health!" | www.aphlblog.org
This year APHL is partnering with Research!America for Public Health Thank You Day! On Monday, November 24th, take the time to thank the many public health professionals who work hard to keep you, your family and your communities healthy. Even though they often work behind the scenes, public health professionals are there protecting you.

We simply cannot say “THANK YOU!” enough to our members, the unsung heroes in lab coats! So we are going to take to our many social networks and say #ThankYouPublicHealth! Add the hashtag on Facebook, Twitter, Pinterest, Instagram or any other network that uses hashtags. Complete the sentence…
Say "Thank You, Public Health!" | www.aphlblog.org

 

#ThankYouPublicHealth for stopping Ebola in its tracks!

#ThankYouPublicHealth for that tiny heel prick that saved my baby’s life! #newbornscreening

 

Or simply add it to a shared article or photo!

If you have space, add the official Public Health Thank You Day hashtag #PHTYD and #APHL. We’ll be watching for posts and will share our favorites! If you would are not active on any of these social networks, leave a comment below and we’ll share for you.

Most importantly, we just ask that you shout it from the virtual rooftops… #THANKYOUPUBLICHEALTH!

Check out Research!America’s website for more great Public Health Thank You Day resources.

 

 

 

 

 

 

 

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Public Health and Freedom: Reflecting on Berlin, AIDS and Ebola

Nov 13 2014 :: Published in General

By Scott J. Becker, executive director, APHL

Twenty-five years ago I was huddled by a radio listening to the BBC broadcaster tell of the fall of the Berlin Wall. As I listened, I became more and more aware of how much Americans take our freedom for granted.

Earlier that same week I moved to Geneva, Switzerland to begin an assignment with the World Health Organization (WHO); not only was it a big move, it was also my first ever trip overseas. I was in a temporary apartment, didn’t speak the language (French), didn’t know anyone and, although very excited, was generally overwhelmed. Meanwhile, only a few hundred miles away, history was being made. I didn’t realize it at the time, but those first few weeks in Geneva helped shape my career and, really, the person I became from that point forward.

Public Health and Freedom: Reflecting on Berlin, AIDS and Ebola | www.aphlblog.org

My assignment at WHO was to coordinate a global conference on integrating HIV/ AIDS into the curriculum of health professional schools across the globe. While healthcare professionals weren’t scared like they were when the disease was first discovered, they really didn’t have much experience with HIV/ AIDS. So my project was to integrate this disease into curricula to teach a new generation of healthcare workers. It was an exciting and difficult challenge not only because of the heavy subject matter at hand or the language which was still unfamiliar to me, but also because I had to navigate the complex bureaucracy of WHO.

When I began this project, the public was just beginning to understand that HIV wasn’t a gay disease or an African disease, but it was a disease that could impact anyone. In fact, we were seeing heterosexual transmission explode in Africa. There was a huge stigma attached to AIDS causing those who were infected to be shunned in public and in the workplace.

As the international conference commenced in Istanbul, Turkey, I felt enormous pride that we were doing something, but it was short lived. One day a man who was HIV positive showed up at the meeting looking for care. Despite being unable to publicize the meeting because of the stigma, this man heard that all these health professionals were coming together in his city to discuss his disease. He was desperate and really had nowhere to turn in his community. He was an outcast and felt like he lost his freedom. The man cried when we told him that it wasn’t really a medical meeting and that we weren’t able to help him directly. My heart broke. I remember going back into the meeting and sharing his story with a colleague from the Turkish health ministry who took down his information and promised to reach out. (I’m fairly certain he did that to placate me, not for real follow up. I’ll never know for sure.)

By that point the Berlin Wall was fully down, people were passing back and forth between East and West Germany, and we were getting glimpses of hope for the future. Back in Geneva, I began to explore the connections between global public health and basic human freedoms. The fall of the wall and my experiences in Istanbul really solidified my desire to be part of improving health for all. It was abundantly clear that good health provided freedom in so many ways. I had found my niche.

I’ve thought a lot about the man in Istanbul recently as I’ve listened to stories about Ebola. Here, too, we have a new and very scary disease. Except that it’s not really new, but new to many in America. The stigma now being associated with Ebola is much like that of AIDS 25 or more years ago. The treatment of returning healthcare workers – heroes, in my mind – is shameful and disappointing. The lack of respect for information shared by scientific and medical experts, people who have studied Ebola for their entire career, is frustrating. And the worst of all, watching public fear escalate and place demands on decision makers is deeply troubling.

Healthcare workers in any region – whether those testing samples in New York City or those treating patients in Sierra Leone – deserve their freedom to move freely until medical experts determine they present a risk to the public. Patients who have recovered from Ebola deserve their freedom as they return to life in good health. And we all deserve freedom from fear, something that is given to me every time I speak with colleagues who understand the intricacies of how Ebola operates and how it can be contained.

My hope for the future is that we as public health professionals, healthcare workers, neighbors and as Americans can move beyond stigma to a better place, one where health is recognized as both a right and a freedom.

*Photo: World Health Organization’s headquarters in Geneva, Switzerland

 

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Biomonitoring and the Public Health Laboratory: Everything You Want to Know

Oct 23 2014 :: Published in Environmental Health

Biomonitoring and the Public Health Laboratory: Everything You Want to Know | www.aphlblog.org

Simply stated, biomonitoring allows public health practitioners to understand whether environmental contaminants are being absorbed into people’s bodies. Given improvements in technology; the capabilities and expertise that now exist in public health laboratories; and the increasing public demand for more information about chemical exposures, biomonitoring is poised to become an integral component of public health practice.

APHL proudly recognizes all of the great work public health laboratories are doing to advance the practice of biomonitoring. We have made it a priority to share these biomonitoring achievements through a variety of channels.

Just in case you missed these great resources and stories, they are here:

Free Webinars

Blog posts and Lab Matters Articles

Fact Sheets

Other resources

Tell us what you think: EH@aphl.org.

 

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For Global Handwashing Day, the ABCs of Washing Your Hands

Oct 15 2014 :: Published in Infectious Diseases

Did you know that today, October 15, is Global Handwashing Day? It’s true! Even without a designated day, proper hand washing should always be a priority.

Why is hand washing so important?

  • It is estimated that washing hands with soap and water could reduce diarrheal disease-associated deaths by up to 50%. (CDC)
  • Researchers in London estimate that if everyone routinely washed their hands, a million deaths a year could be prevented. (CDC)
  • Handwashing can reduce the risk of respiratory infections by 16%. (CDC)
  • Handwashing with soap at critical times could help reduce school absenteeism by around 42 percent. (PPPHW)
  • When hand hygiene compliance in health facilities increases from less than 60% to 90%, there can be a 24% reduction in MRSA acquisition. (WHO)

What exactly is proper hand washing? It’s important to wet your hands with clean water and use soap. Rub your hands together and be sure to get every bit of your hand. Keep scrubbing for 20 seconds! We asked a few of APHL’s most special partners to demonstrate proper hand washing including a fun way to know you’ve been scrubbing for 20 seconds. Check out the video below and be sure to pass the message along!

 

ABCs of Good Handwashing from APHL on Vimeo.

 

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FDA Proposes Oversight of Laboratory Developed Tests: Is This Good for Public Health?

Oct 09 2014 :: Published in Public Policy

By Celia Hagan, MPH, Senior Specialist, Public Policy, APHL

It finally happened.

After an extended silence and lack of significant action since their 2010 public meeting on the oversight of laboratory developed tests (LDTs), the Food and Drug Administration (FDA) released their long awaited draft regulatory framework for LDTs. While the official comment period was announced in the Federal Register on October 3, 2014, this isn’t the first time that we’ve seen the outlined framework.

FDA Proposes Oversight of Laboratory Developed Tests: Is This Good for Public Health? | www.aphlblog.org

Just this past July, FDA released a Notice to Congress indicating their intent to move forward with regulation. At the same time, they provided public access to the draft oversight framework. During the 60-day period between July and October, APHL has been hard at work analyzing and interpreting the framework to assess and understand the impact on public health laboratories.

The proposed framework will regulate LDTs in a risk based approach, similar to the way medical devices are currently regulated. Due to growing concerns about the lack of clinical validity, FDA is proposing premarket review requirements to establish these characteristics in LDTs and the establishment of a quality system to assure the finished device will be safe and effective. Laboratories that manufacture or utilize LDTs will be required to notify FDA of their LDT inventory six months after the date of the published final rule. This will allow FDA to classify LDTs into risk categories. The requirement to establish the test’s clinical validity through premarket review will depend on how LDTs fall into these risk categories. While every laboratory will be required to comply with notification and medical adverse reporting no matter what the risk, high risk and moderate risk LDTs will be subject to premarket review requirements. Low risk LDTs will be allowed enforcement discretion with respect to premarket review.  (FDA will classify LDTs into risk classes at a later date.)

FDA is also allowing some enforcement discretion with respect to premarket review for:

APHL strongly supports accurate and quality testing. Public health laboratories exist because they are nimble, prepared, responsive and adaptive; therefore, as FDA gathers feedback on its proposed LDT regulation, APHL will advocate for a framework which will not inhibit the critical services provided by public health laboratories. The innovation and evolution, not to mention the daily activities, of the public health laboratory system relies on an LDT regulatory framework that is not so burdensome that it unintentionally eliminates testing that provides important public health benefits. APHL has engaged FDA’s leadership to communicate the necessity of continuing the services provided by public health laboratories within any LDT regulatory framework. In addition, APHL has educated congressional staff on the critical role of public health laboratories within the public health system.

As the 120-day comment period comes to an end on February 2, 2015, APHL will submit a thoroughly considered and carefully crafted comment to ensure that services provided by public health laboratories continue to improve the public’s health. We encourage others who support public health to voice their interest in maintaining this valuable work.

FDA will host an informational webinar on October 23, 2014, at 2:00 pm EDT. More details can be found on FDA’s website. In addition to the submission of formal comments to regulations.gov, APHL will present at FDA’s public comment meeting in January 2015 (details to be announced at a later date). See you there!

 

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Family Stories are the Best Way to Grasp the Value of Newborn Screening

Sep 18 2014 :: Published in Newborn Screening and Genetics

By Michelle M. Forman, senior media specialist, APHL

Family Stories are the Best Way to Grasp the Value of Newborn Screening | www.aphlblog.org

Did you know that September is National Newborn Screening Awareness Month? Even though this simple test is performed routinely on all babies born in the United States, it is still important to understand what it tests for and what to do if your baby has abnormal results. There is no better way to grasp the value of newborn screening than through the stories of families who have lived it.

I have gone through the newborn screening process twice, once with each of my children. The nurse came, whisked the baby away for a quick test and brought her/him back with a bandage on their heel. If I didn’t work in this field, I probably wouldn’t have asked. There was just too much going on during those days in the hospital. But I did ask – and I asked the pediatrician for their results. Fortunately, my children’s results were both normal.

Yes, newborn screening is looking for conditions that are extremely rare. Yes, the odds are that your baby does not have one of these hereditary conditions. But it is possible that they do and, if caught early by this amazing public health service, they can be treated and go on to live a healthy life.

After coming to know the families who shared their stories with me, seeing my baby taken to the nursery for that little heel prick was of immense comfort. Below is a list of all of the personal and family stories we have on our blog sorted by condition. They are stories of fear, stories of close-calls and many are stories of joy. Were it not for newborn screening, these families would have dramatically different lives than they do now. But instead, they are watching their children reach milestones, win awards, graduate and even start families of their own.

Thank you to the nurses, doctors, laboratorians and advocates working on newborn screening every day!

3-methylcrotonyl-CoA carboxylase deficiency (3-MCC)

Biotinidase Deficiency

Congenital Hypothyroidism

Critical Congenital Heart Disease (CCHD)

Cysitic Fibrosis

Galactosemia

Isovaleric Acidemia

Malonic Aciduria

Maple Syrup Urine Disease (MSUD)

Phenylketonuria (PKU)

Propionic Acidemia

Severe Combined Immunodeficiency (SCID)

Sickle Cell

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Enterovirus D68 Testing, Surveillance and Prevention: What We’re Telling Our Friends

Sep 11 2014 :: Published in Infectious Diseases

By Laura Iwig, MPH, Senior Specialist, Infectious Disease Program, Stephanie Chester, MS, Influenza Program and Kelly Wroblewski, MPH, MT (ASCP), Infectious Disease Program, APHL

Fall brings the start of many things every year – school, of course, but also respiratory virus season. And this year as both kick-off we’re faced with an outbreak of a virus that is new to many, enterovirus D68 (EV-D68). Terrifying headlines have loaded up our Facebook newsfeeds, so we’re here to straighten things out a bit. When our friends and family ask us about EV-D68, this is what we tell them.

Enterovirus D68 Testing, Surveillance and Prevention: What We’re Telling Our Friends | www.aphlblog.org

First of all, there are many enteroviruses and D68 is just one type. What makes EV-D68 unique is that it is causing severe illness in some people, particularly children which is always cause for concern. Keep in mind that while there are severe cases being reported, there very likely are also less severe cases of EV-D68 with typical cold-like symptoms going unreported. The number of severe cases is not necessarily the full picture. Despite there being no vaccine or specific treatment for EV-D68, it typically resolves itself without any complications.

We know this all sounds kind of scary especially when news reports are focusing on the most severe cases. But it is important to understand that the clinical and public health communities are well-equipped to deal with enterovirus outbreaks and actually respond to similar outbreaks on a routine basis. We and our partners are prepared.

Clinical, commercial and public health laboratories are conducting testing to determine if severe cases and/or outbreaks are being caused by an enterovirus or closely related rhinovirus. (Not specifically D68 – we’ll get to that below.) Many of these labs utilize rapid molecular methods to detect a wide array of respiratory pathogens, including enteroviruses.

If testing confirms that you do have an enterovirus and if you have severe symptoms, CDC is conducting additional testing to determine which type of enterovirus you may have. For the public, the value in differentiating EV-D68 from other related viruses is to provide real-time information to your doctor to help recognize symptoms associated with severe cases, identify them and get them early supportive treatment. For example, if your child has an underlying condition such as asthma and comes down with a cold that starts to become severe, his doctor might want to be more proactive in supportive care if they have learned from public health officials that EV-D68 was detected in your community. Knowing that it is EV-D68 is in the community or even a specific school can impact public health infection control measures and raise awareness for patients and parents to be more proactive about intervention if their child does get sick.

There is also significant value to the scientific and public health communities in determining if enterovirus cases and outbreaks are caused by EV-D68. Historically, this particular type of enterovirus has been rarely reported so we are still learning how easily it transmits, who is at risk for severe illness and how widespread the virus may be. In fact, some scientists are wondering if EV-D68 is truly as rare as many think or if our testing capabilities have improved allowing us to detect more cases. Science is a never ending process of information gathering. While most actions won’t be any different from other respiratory outbreaks if even if epidemiological and laboratory surveillance activities detect EV-D68, these investigations may change how we deal with outbreaks like these in the future making us more prepared.

What can you do to protect yourself and your family?

  • Wash your hands frequently with soap and water! Alcohol based hand sanitizers do not work against enteroviruses.
  • Avoid close contact with those who are sick.
  • Clean and disinfect surfaces, especially those touched by those who are ill. The virus can be easily killed on surfaces.

For now, we are reassuring our friends and family that the clinical and public health communities are prepared and are responding to this outbreak. That gives us peace of mind and hopefully it will do the same for you.

 

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In US, Massive Effort to Detect and Respond to Ebola Already Underway

By Tyler Wolford, MS, Specialist, Laboratory Response Network, APHL

Our curiosity and fears have been running wild since the 2014 Ebola* outbreak in West Africa hit headlines. Scenes from Outbreak, the 1995 box office hit that focused on a fictional outbreak of an Ebola-like virus in Zaire, begin running through our minds. We need to stray from these dramatizations and focus on the facts. Movies are supposed to build suspense and fear, but real life outbreaks don’t happen like they do in the movies. This isn’t Hollywood.

In US, Massive Effort to Detect and Respond to Ebola Already Underway | www.aphlblog.orgThe most common question on the minds of people around the United States: Are we fighting Ebola well enough to keep it from coming to my community?

The truth with many emerging infectious diseases including Ebola, is that the only way to fight it is to be prepared to respond. In the United States, we’re doing just that.

Although the Ebola-Zaire virus circulating in West Africa has not arrived in the United States, a massive effort is underway to detect and control any isolated cases of the disease should they occur in this country. The Centers for Disease Control and Prevention (CDC), the United States Department of Defense (DoD), pharmaceutical companies, public health laboratories and many more are all working domestically and abroad to minimize the potential threat. The DoD has long been studying Ebola virus and successfully developed a test to detect the Zaire strain. On August 5, 2014, the DoD Ebola detection test received emergency use authorization (EUA) by the Food and Drug Administration (FDA) to be used in this extreme circumstance. (An EUA expedites the FDA approval process for unapproved medical devices that could benefit response efforts when no adequate alternatives exist.) After the EUA was issued, CDC worked quickly to deploy the test to select public health laboratories across the United States. As the supply of test kits increases, CDC will look to expand the number of laboratories qualified to detect the Ebola-Zaire virus.

The public health laboratories receiving the Ebola detection assay are part of the Laboratory Response Network (LRN), a specialized network of laboratories that are capable of responding to biological, chemical, radiological and other emerging threats. This preparedness and response effort is not unique to Ebola. Most recently, the LRN has been leveraged to respond to emerging infectious diseases like Middle East Respiratory Syndrome – Coronavirus. The LRN provides a strong infrastructure of trained personnel, clear communication lines, and advanced technology to launch an effective response to emerging infectious disease.

The race to contain Ebola is on since the World Health Organization (WHO) declared the Ebola outbreak a Public Health Emergency of International Concern (PHEIC) in early August 2014. Moreover, the CDC has activated its Emergency Operations Center at the highest response level to help with the outbreak. As Dr. Tom Frieden, CDC director, said in a press conference this week, “We know how it spreads. We know how to stop it from spreading. The challenge is to do that everywhere that’s needed. In order to do that effectively, speed is key.”

While we all are concerned for the health and safety of the people in the most affected nations, we can find some comfort in knowing that a coordinated effort of qualified scientists, doctors, public health officials and organizations is underway to minimize the threat of outbreak in the US.

*Did you know there are five known strains of Ebola virus? The most dangerous one, Ebola-Zaire, is responsible for the outbreak in West Africa. The virus spreads person to person through direct contact with blood and other bodily fluids; despite what you may have read in fear-mongering articles, the spread of the virus through the air has never been documented. Once inside the host, the virus works by weakening the immune system and starving the host organs to the point of failure.

 

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