A UN-sponsored report on Monday denounced the World Health Organization’s slow response to the Ebola outbreak and said the agency still did not have the capacity to tackle a similar crisis. “It is still unclear to the panel why early warnings approximately from May through to July 2014 did not result in an effective and adequate response,” an interim report by a six-member expert team said. WHO only declared a global public health emergency on August 8 — almost five months after the outbreak had taken hold in west Africa. The panel, set up on March 9, is led by Barbara Stocking, who formerly headed Oxfam.

Source: news.yahoo.com

So what have we learned from the last 13 months?


It was April 10th, 2014 when I posted my first review and warning about Ebola’s migration habits or patterns, and the need for Medical GIS to be available outside the WHO and CDC settings.  It is important to remember that WHO and CDC are organization, pretty much agencies behaving like businesses, that have other agendas to consider.  The primary agenda is world stability, politically, financially and, oh yeah, healthwise.


Two more months passed before either agency paid much attention to the facts about ebola.  Unfortunately, even the total facts about spatial habits of diseases like ebola. was a knowledge base both WHO and CDC lacked enough experience with to foresee the reasons for the upcoming cascading of this outbreak.  


Historical epidemics demonstrate these patterns.  They have their ebbs and flows just like the plagues and contagion before.  For medical historians, it is nice that history repeats itself; this concept however is most because people repeat themselves, including their bad habits and poor learning curve following recent and new outbreaks.


So what have we learned?  The news tells it all:


LESSON 1.  May 12:  As Ebola disappears, no useful data seen from vaccine trials -WHO.   http://finance.yahoo.com/news/ebola-disappears-no-useful-data-122852064.html 


We allocated money in the wrong directions.  Pharma companies effectively convince investors and health officials that they had the cure.  Internal benefits linked to these actions helped fuel these tests of the new medications.  The patenting of a bioengineered plant phenotype that produces an antiviral drug was one result; the proof that we (NIH and CDC) need to patent the deadliest ebola of all, because we need to have control of this bioweaponry – – against future outbreaks that is.


Instead, this money should have been completely allocated to just two things–surveillance and cessation/prevention activities to prevent the further spread of Ebola.


LESSON 2.  Adam Justice.  May 12.  Ebola: Liberia celebrates as WHO declares the nation clear.   https://uk.news.yahoo.com/ebola-liberia-celebrates-declares-nation-clear-085546124.html 


FOX News.  May 11.  Liberia declared Ebola-free, but outbreak continues over border 



When it comes to the global outbreak and rapid rise in numbers, nothing is final.   While Liberia celebrates, the disease remains active just across the border.  In fact, we saw this happen between at least 3 countries in Africa.  While you appease one side with money and tactics, the carriers remain at large.  This is due to ignoring the first warnings, lacking an effective intervention plan for when the outbreak ensues, lacking trained professionals with expert experience in the plague known as ebola, and inadequate education and experience as an organization–no proper foresight.    We always forget our mistakes deliberately–we can’t accept them and handle them–and we certainly won’t admit them–so the line in this articles taht states:  "Now comes the challenge. The challenge of working with our two neighbouring countries. To make sure they reach the same level of progress that we have reached" means you still have a lot of convincing of others to accomplish–this epidemic is not over.


The Solution:  Eliminate current plans and procedures, replace inadequate staff, invest more in the GIS/HIT needed for surveillance and reporting outside the two major agencies, and regional/state/county agencies with attached agendas.  Each business (insurance or tertiary care giver) has a responsibility for trusting only itself when it comes to smart corporate decision making.  Big Business suffers the most, when expenses needs to be covered for an outbreak their auditors and regulators failed to prevent.  Its like a government charging the taxpayers for not fixing up the roads.


LESSON 3.  Doctor Who Survived Ebola Nearly Lost His Vision.  http://news.yahoo.com/doctor-survived-ebola-nearly-lost-vision-145513068.html   


Too much favoritism and elitism are found in medical profession behaviors.   Crozier and others failed to abide by their own public health and safety rules.  And there is no way this will even NOT HAPPEN.  People are into "the self"–the self’s desire for some fast food picked up by a drive through (where the card or paper money spreads the disease, like it did with cholera), the self’s desire to get home or to a relative’s place no matter what–no matter how many hundreds to thousands of people you potentially expose directly and indirectly.  We punished the newscaster who did not abide by her requirements; we failed to treat the others accordingly.  Nature showed Crozier that he made a terrible professional decision related, unethical mistake.


SOLUTION:  be more responsible in catching and/or quarantining these types.


LESSON 4.  May 12.  Experts denounce WHO’s slow Ebola response.   http://news.yahoo.com/experts-denounce-whos-slow-ebola-response-101853741.html 


Ebola: Expert panel urges ‘unified entity’ within WHO for emergency response 



It is not over until it’s over–and perhaps may never be over.  This in fact should say, "A third new group of experts who reviewed the outbreak of Ebola felt WHO and CDC could have performed better."    The "Unified Entity" some nations are talking about is idealistic, not realist.




LESSON 5.  May 12.  Experts denounce WHO’s slow Ebola response (Update).  http://medicalxpress.com/news/2015-05-experts-denounce-ebola-response.html 


What happens to WHO influences and/or also happens to CDC.  Recall, there was a 180 turn around in CDCs claims in July 2014.  For just one day, WHO’s statements were in disagreement with CDC’s statements, claiming that there was a new outbreak that required immediate reaction.


SOLUTION: 90% of all surveillance per ICD/disease type should be done outside WHO and CDC.  Multiple agencies interacting with each other make it less likely for governmental decisions to endanger local, national or global public health.   90% of all public health activities, for an outbreak like ebola, or measles, or cholera, should be performed by local interest groups first using GIS, then the national and international groups.  And those local groups should encompass more than just your regional, county or state health departments.


See on Scoop.itMedical GIS Guide

Measles can harm the immune system for up to three years, leaving survivors at a higher risk of catching other infectious and potentially deadly diseases, researchers said Thursday. It was previously known that measles could suppress the body’s natural defenses for months, but the findings in the journal Science show that the dangers of the vaccine-preventable disease last much longer, by wiping out essential memory cells that protect the body against infections like pneumonia, meningitis and parasitic diseases. “In other words, if you get measles, three years down the road, you could die from something that you would not die from had you not been infected with measles,” said co-author C. Jessica Metcalf, assistant professor of ecology and evolutionary biology and public affairs at Princeton University. Measles is one of the most contagious diseases of all.

Source: news.yahoo.com

Sometimes, we in the health profession are so behind in our protocols and knowledge base.  This public health concern regarding measles has been around for more than a decade in popular culture; western medicine in the US and developed countries have for the most part has turned their heads away from this important health matter.  Any individual with a child should be concerned about the current immunization refusal problem for this very reason–SSPE.  


The single most important public health risk to pay heed to in the upcoming years is SSPE or Subacute Sclerosing Panencephalitis, a medical condition that ensues several years after a child come in contact with measles before being vaccinate.  SSPE develops when the measles virus re-emerges in the body, and infects predominantly neurological tissue.    


Historically, SSPE prevailed in parts of Europe where vaccinations for the disease were scarce.  More recently, cases have erupted in developed countries, due to families with parents that refused to allow their children to have the measles vaccine, of due to exposure of their child under 1 years of age (vaccines are given to 1+ years old), to someone else’s child who has the measles due to lack of vaccination.    

VIDEO (Educational):  Emmalee Smith’s "The Measles: an Epic Movie".  https://www.youtube.com/watch?v=z6WT_BV-tjM   


VIDEO.  Oxford University:  SSPE – A serious complication of Measles. https://www.youtube.com/watch?v=aB8kGwKZiq0    


Merck Manual, SSPE:   http://www.merckmanuals.com/professional/pediatrics/miscellaneous-viral-infections-in-infants-and-children/subacute-sclerosing-panencephalitis-sspe  


Medline’s page on SSPE:    http://www.nlm.nih.gov/medlineplus/ency/article/001419.htm   


The WHO Committee meetings on SSPE:  


"Subacute sclerosing panencephalitis and measles vaccination

Committee reports".  http://www.who.int/vaccine_safety/committee/topics/measles_sspe/en/  


These are my pages on SSPE:  


Brian Altonen.  "The Answer is Obvious: MMR or the possibility of SSPE ? Your choice."   



My Tumblr on SSPE and a number of other Public Health concerns.   




SSPE could become the news in the U.S. by 2020, with California or any of several places where measles outbreaks are having their effect the lead states in this potential and highly costly public health disaster.  See http://www.scoop.it/t/an-episurveillance-researchers-guide/p/4037070036/2015/02/11/california-warns-against-intentional-measles-exposures 


SSPE is placed next to an unfortunate outbreak of Poliomyelitis in children as the most costly, most debilitating, most deadly class of re-emerging diseases linked to childhood immunization refusals in the U.S..


See on Scoop.itNational Population Health Grid

“In the U.S., the pneumonic plague is found among prairie dogs in the Southwest, and an estimated 8 people contract it every year. 

“The bacteria that causes all plague, Yesinia pestis, is also found in the infamous bubonic plague, spread by rats in the Middle Ages and responsible for wiping out millions of people in Europe. (Note: pneumonic = respiratory, bubonic = lymphatic)”

Source: www.womansday.com

"And according to a newly-released U.S. Centers for Disease Control and Prevention report, one Colorado man contracted the potentially fatal infection when his pit bull terrier coughed on him.


His dog started showing symptoms (including fever and a rigid jaw) last summer and was euthanized. But days after the dog’s death, the owner was admitted to the hospital with a fever and a bloody cough. After 23 days in the hospital, he successfully recovered, along with three other people — one of his friends and two veterinarians — who were also infected."



My NPHG Video on the plague is at — https://www.youtube.com/watch?v=A78AZDxO0II

See on Scoop.itNational Population Health Grid

Watch the video Dog infects humans with plague for first time in U.S. on Yahoo Finance . Vet Emergency & Referral Group Director Dr. Brett Levitzke on a plague-infected dog that spread the disease to people in Colorado.   [Image source:  http://blogs.wsj.com/ideas-market/2012/06/26/the-plague-still-stalks-the-u-s-west/ ]

Source: finance.yahoo.com

When diseases are heavily dependent upon human populations and factors strongly related to human populations, like domestic pets, the standard behaviors for these diseases result in a diffusion pattern that can sometimes demonstrate preference for population centers.  This particular outbreak in Colorado appears to demonstrate this change in behavior.  Important to note however is that there is an ecological aspect to this cluster of plague cases that prevents the plague from easily migrating in an eastern direction.  However, an increase in the role of  domestic animals in forming the migration patterns could change these traditional diffuse patterns considerably.   


My review of the plague, in US EMR/EHR, does demonstrate a density in the population centers of the eastern US.  See https://www.youtube.com/watch?v=A78AZDxO0II 

See on Scoop.itMedical GIS Guide

SEATTLE (AP) — A 16-year-old boy who fired two gunshots Monday inside a Washington state high school, hitting no one before a teacher tackled him, told detectives he never intended to hurt any students, a police spokesman said.

Source: news.yahoo.com

What are the spatial determinants for this?  Population density?  Rural versus urban?  Pop culture in the school setting?  Large schools versus small schools?  Socioeconomic Status?  Levels of Education? Social and cultural labels?  Race-ethnicity patterns?    


EMR/EHR should be capturing this data right now.  This means that in a year or two, maps like those on display can be produced using your HIT system.  The priorities to accomplishing this goal (in descending order) should be: data completeness, SQL, skillsets, SAS or equivalent (non-GIS), long term storage capacity, virtual space for rapid data description, analyses and reporting.  


The above dataset took just 7-15 minutes to pull and generate 750-1000 maps with, and another hour to produce the video.  For reporting purposes of course, there is no need to make the video.  No GIS was required.  Only the most basic, most standard systems HIT tools.  

See on Scoop.itEpisurveillance

A simple way to tell the difference between neighboring regions is to magnify the results of your spatial data.   This method is used to define where the nidus or nest of a problem exists in the social or community setting.  It can also be used to define where to establish new clinics, or where to focus the bulk of of your intervention activities.    


The simple use of N versus N-squared for your indicator score helps define exactly where the highest risk regions exist.    


High risk is defined in two ways using this method.  The first is the standard amount of events or risk scores obtained per unit area evaluated statistically (n, incidence, prevalence, age-adjusted results, etc.).  The second is the simply square these results in order to identify the exactly location of your most needy community settings.  


This evaluation process requires just a few minutes to be run, in a standard HIT system.  It can be run at the local or neighborhood level, as well as the large area or regional level (like illustrated here).  


The two sets of figures provided come from the following two videos posted at YouTube:


N —   https://www.youtube.com/watch?v=lbg6Z8Ylfm8


N-squared —   https://www.youtube.com/watch?v=If-HKIdoiuc

See on Scoop.itEpisurveillance

Venoms in the U.S.

Venoms in the U.S.


http://youtu.be/GvdzdBTyO2I NaturalPoisoningCases 0536 7

Source: www.youtube.com

Mapping out poisoning cases is a use for NPHG that is pretty much indisputable.  So what does it teach us?

This video is a demonstration of the natural versus human ecology of venomous animals, inferred by the distribution of envenomation cases related to these animals.  An interesting portrayal of cases related to outdoor activities, for comparison with animals with spatial distributions defined by indoor, personal pet keeping practices.

This result may also be related to in-migration of animal vectored disease patterns, and respiratory conditions generated by hypersensitivity to animal dander.

See on Scoop.itEpisurveillance


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