Rebecca Jacobson, Inside Energy
Rebecca Jacobson, Inside Energy
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Thomas Eric Duncan, the Liberian citizen visiting the U.S., died this morning. He was the first and so far only patient to be diagnosed with Ebola in the United States. It’s important not to trivialize his death, but it’s also important to put it in perspective. In Africa, the virus has claimed the lives of at least 4,033 people and sickened more than 8,300 others, according to the World Health Organization.
But that one case has captured the news, inspiring headlines like “The ISIS of Biological Agents” and “U.S. has left itself open to Ebola outbreak.”
Meanwhile, in our country, the enterovirus 68 has infected at least 628 people since August, most of them small children.
“When people are anxious about a threat like Ebola, it doesn’t necessarily matter if they look at numbers, facts and probabilities,” said Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases. “Because of the way our brains work, something rare and exotic is much scarier than something that’s familiar.”
As anxiety about Ebola mounts, we asked the experts which U.S. diseases we should be worried about, or at least more worried about than Ebola. Here are six, in no particular order.
Last month a 4-year-old boy in New Jersey went to sleep and never woke up. This week, the CDC confirmed that the boy was infected with the enterovirus 68, or EV-D68. That same week a 10-year-old girl who also tested positive for the virus died 24 hours after being admitted to a hospital in Rhode Island.
Enterovirus 68 fits into a class of viruses that includes hand-foot-and-mouth disease and polio. Every year, 10 to 15 million people pick up an enterovirus, Schuchat said, but enterovirus 68 is an entirely new outbreak.
While enterovirus 68 was first discovered in 1962, this is its first outbreak. Dr. Mary Anne Jackson is director of infectious diseases at Children’s Mercy Hospital in Kansas City, Missouri. The first cases of enterovirus 68 — children with asthma-like symptoms — were admitted to her hospital early August. By month’s end, the hospital was admitting to 30 to 35 cases a day.
Just as doctors are learning how to diagnose the virus, it is evolving. In Colorado, 10 patients developed polio-like symptoms, with limb paralysis and difficulty breathing. Four of those patients tested positive for enterovirus 68. Similar cases have been reported across the country, from Boston to San Diego. It’s still unclear whether limb paralysis is linked to enterovirus 68, but researchers are studying the possibility of a connection.
“It spreads just like the common cold, but we don’t know how many will get a cold and how many will need hospitalization and how many will end up with polio-like illness,” Jackson said. “In terms of what’s at our feet right now, EV-D68 has become the most important virus.”
How to protect yourself: Wash hands often with soap and water for more than 20 seconds before touching eyes, nose or mouth. Avoid close contact with people who are sick. Cover your coughs and sneezes with something that’s not your hands. Disinfect surfaces, like toys and doorknobs. Stay home if you’re sick.
This child displays a typical measles rash, four days into the illness. Before widespread vaccination, 90% of children and babies contracted the measles. The number dropped to fewer than 1,000 cases a year, and was nearly eradicated in the U.S., until parents stopped vaccinating their children. Photo courtesy CDC/NIP/Barbara Rice
Measles, a virus that causes an infection of the respiratory system, was nearly eradicated in the United States after a vaccine became widespread in the early 1960s. In the years since, the virus became so rare here that its symptoms — irritability, high fever and a rash — were mostly forgotten, as was the rate of infection. Before routine vaccinations, each case of measles created 17 new secondary cases, the New York Times recently reported.
But in 2008, due to a combination of international travel and unvaccinated populations — most from parents opting out of the measles-mumps-rubella vaccine for their children — the virus resurfaced in the U.S.
Babies of unvaccinated mothers are at the greatest risk. They are too young for the vaccine and lack immunity from their mothers. So far in 2014, there have been more than 600 measles cases, nearly all of them children.
“That’s astounding for 2014 to think that there are that many cases for a disease that should have gone away in the U.S.,” Jackson said.
Measles is rarely fatal — one person in every 1,000 cases dies from it — but it requires a great deal of hospital resources to treat. Many children with the measles will need oxygen or ventilators, and are at a greater risk of developing pneumonia and other bacterial infections. Measles can also cause deafness and permanent brain damage.
In rare cases, children with the measles go on to develop subacute sclerosing panencephalitis. SSPE is a rare neurological disease that develops years after a measles infection. It starts as sleeplessness and forgetfulness, but it devolves into hallucinations and seizures. Most SSPE patients die within one to three years of diagnosis.
How to protect yourself: For best protection, the CDC recommends vaccinating your children twice: once when they are 12-15 months old, and again when they are 4-6 years old.
This is the bacteria that causes pertussis, or whooping cough. The current vaccine for disease loses efficacy after 5 years. Missed booster shots means the disease is showing up more often in the U.S. Photo courtesy Sanofi Pasteur/Alain Grillet via Flickr
Cases of pertussis, or whooping cough, have risen sharply since 2004. In 2012, 48,277 cases were reported in the U.S. That’s the largest number since 1955. Pertussis is caused by a bacteria, and starts with cold-like symptoms. The dry, hacking cough can last for up to 10 weeks. Some patients turn blue gasping for air.
“In my 30 years of practice, hardly a week has gone by that I haven’t diagnosed a case [of pertussis],” Jackson said.
Children between 7 and 10 years old are hardest hit, she said, and it’s especially dangerous for infants. But deaths in the U.S. from pertussis are rare. There were 20 deaths among the 48,277 cases in 2012, for example.
“Deaths are low — 20 to 30 a year,” Jackson said. “Those are 20 to 30 deaths that we shouldn’t have.”
There is a vaccine for pertussis, but it’s not as effective as it once was, Jackson said. In the 1950s, the U.S. relied on a whole-cell pertussis vaccine, one that used full strains of the bacteria. But the whole-cell vaccines had side effects, from swelling at the injection site to fever. In the 1990s, industrialized nations shifted to using an acellular vaccine containing only parts of the bacteria. But after five years, immunity from the acellular vaccine wanes. Then around 2004, the bacteria mutated, and cases took off in the U.S.
NewsHour’s Betty Ann Bowser reported on the outbreaks in 2012:
How to protect yourself: Regular booster shots help, Schuchat said, especially for pregnant women who want to protect their newborns. Mothers can pass immunity on to their babies, which helps them through their first months. In fact, a whooping cough booster shot in the third trimester protects 90 percent of babies in their first year of life, according to the CDC.
Methicillin-resistant Staphylococcus aureus (MRSA) has spread beyond hospitals. The deadly, antibiotic-resistant bacteria is found on every two out of 100 people in the U.S. Photo courtesy CDC/James Gathany
More than 2 million people in the U.S. each year develop an infection from antibiotic-resistant bacteria. The CDC estimates at least 23,000 people die from those infections each year.
With an overuse of antibiotics, several types of bacteria have become immune to the drugs that once eliminated them. Infections and diseases that were once cured by a single medication now require stronger antibiotics to treat. Doctors have seen rises in antibiotic resistant tuberculosis, staph infections, gonorrhea and pneumonia, to name a few. It means long, painful and expensive hospitalizations while doctors find a way to kill the superbugs. When second- and third-tier antibiotics can’t cure the infection, the last resort is removing infected tissue.
Methicillin-resistant Staphylococcus aureus, or MRSA, is one of the most virulent. The CDC estimates that there are 80,000 MRSA cases every year, and 11,000 people die from the infection each year. MRSA can be spread through skin-to-skin contact and contact with infected materials, like surgical tools or breathing tubes. It’s a scourge in hospitals, and it is spreading beyond clinics.
But there has been a decline in MRSA deaths. In 2011, there were 9,000 fewer MRSA deaths than in 2005, the CDC estimates, thanks to better hospital practices to prevent the spread of the bacteria. But two in every 100 people carry MRSA.
How to protect yourself: Protect yourself with handwashing, proper sanitation and appropriate use of antibiotics, Schuchat said.
RESPIRATORY SYNCYTIAL VIRUS
Chest x-ray of a 16-day old infant with a lung injury due to respiratory syncytial virus. Almost every child contracts the disease by age 2. Photo courtesy Wikimedia.
By age 2, almost every child in the U.S. has had respiratory syncytial virus or RSV, Jackson said. It’s a lung infection, causing babies to cough, wheeze and have a fever. RSV is transmitted like a common cold via droplets from sneezes and coughs. Like the flu, it appears every winter like clockwork, Jackson said.
For most babies, RSV isn’t serious, but 125,000 babies every year are hospitalized for the virus. Premature babies or children with heart or respiratory problems can develop more severe symptoms and require ventilators or oxygen to breathe. Overall, the death rate from RSV is low considering how high the infection rate is — approximately 250 deaths a year, Jackson said.
So why is RSV a big problem? Unlike influenza, there’s no vaccine or antiviral to treat it. The virus stays on surfaces for as long as eight hours, spreading quickly through daycares and households. For the elderly and older smokers, RSV can cause pneumonia, which can be deadly.
“The vast majority of babies do fine, but it has a very high burden of disease,” Jackson said.
How to protect yourself: Wash your hands frequently. Disinfect surfaces. High-risk children should not interact with people with cold-like symptoms.
From the CDC: A drug called palivizumab (say “pah-lih-VIH-zu-mahb”) is available to prevent severe RSV illness in certain infants and children who are at high risk. The drug can help prevent development of serious RSV disease, but it cannot help cure or treat children already suffering from serious RSV disease and it cannot prevent infection with RSV.
INFLUENZA AND PNEUMONIA
In January 2013, New York City declared a public health emergency as influenza swept the state, with nearly 20,000 people infected. Photo by Getty Images/Mario Tama
Influenza and pneumonia go hand-in-hand, and are more likely to kill you than any infectious disease. Flu ranks number seven on the CDC’s list of 10 top killers. More than 53,000 people died from influenza and pneumonia in 2010 according to the CDC — and that’s just in the United States.
“The common cold is miserable, but this is beyond miserable. It’s a high fever, severe muscle aches…people remember the minute it hits them,” Jackson said. “It runs its course over seven days, and an antiviral can ratchet it down, but (the flu) is still a very severe illness with whole list of complications” — ranging from ear infections to pneumonia.
And while the flu virus itself can be deadly, more lethal is the pneumonia that sometimes follows, she said. Most healthy people, about one-third of the population, carry the bacteria that causes pneumonia in their noses. But when an infection like the flu takes over the body, the bacteria migrates into the bloodstream and ends up in the lungs.
Millions are hospitalized for the illness, Schuchat says, but babies, young children and the elderly are at the greatest risk. That’s why the CDC recommends that everyone over 6 months old gets the annual flu vaccine.
“Last year, more than 100 kids died from flu in the U.S. And that’s something that we do have vaccines for,” Schuchat said. “It may seem familiar, but even healthy children get influenza and can die from it.”
Ebola requires contact with bodily fluids like vomit, blood, saliva or urine to transfer from person to person. But influenza is easily airborne on droplets projected from coughs and sneezes that fly through schools, offices and households. The tragedy is that many of these influenza deaths could have been prevented with the annual flu vaccine, Jackson said.
“We have a vaccine and an antiviral medication for influenza, and it still causes deaths,” she said. “We have Americans afraid of ebola, but fewer than 50 percent of Americans take advantage of the flu vaccine, and it’s something that’s going to be here. It’s coming.”
How to protect yourself: The CDC recommends that caregivers and infants six months and older get a flu vaccine. Also, cover your coughs and sneezes and wash hands frequently. If you’re sick, stay home from work or school.
Correction: An earlier version of this article incorrectly stated the number of confirmed Ebola deaths and labeled the enterovirus 68 as airborne. Enterovirus 68 is believed to spread through contact with saliva on surfaces.
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