Author Archives: Kelly L. Moore, MD, MPH

About Kelly L. Moore, MD, MPH

I am a public health physician specializing in preventive medicine who works to minimize the burden of preventable diseases by guiding the control of outbreaks and promoting the optimal use of vaccines.

A Few Thoughts On Ebola and My Heroes

First identified back in 1976, Ebola has been a remote, almost mythical disease, affecting isolated jungle villages after contact with infected bats or monkeys and (rarely) laboratory workers handling the virus. The current perfect storm in regions of Guinea, Liberia, Sierra Leone, and Nigeria has the makings of a Hollywood horror film. For the first time, the virus has found its way into large urban areas, among impoverished communities without access to adequate health care or public health infrastructure. With resolution likely many months away, I thought it might help to share a little background and inspiration from some of the extraordinary people involved in fighting it.

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The Ebola virus doesn’t spread through the air, but is spread through infected blood and body fluids of a sick person. Unfortunately, the early sign of high fever can be mistaken for malaria or typhoid, meaning unsuspecting family members or healthcare workers can be infected if they don’t protect themselves. Once exposed, illness begins as little as 2 days or up to 3 weeks later. Although public education is everywhere, many people remain fearful of hospitals and their government, so they keep the ill at home, defying quarantine orders and continuing traditional burial practices, spreading the virus in the process. Healthcare workers are exhausted and overwhelmed with patients, ill-equipped to maintain perfect personal protection while caring for so many with so few resources; as a result, doctors, nurses and other healthcare providers have been hard hit in this outbreak. Even leading Ebola experts in these countries have succumbed in recent weeks.

The good news is that WHO and CDC disease control experts have arrived. One of my friends is using her infection control expertise to help health systems in Lagos, Nigeria, and many more experts are working around the clock back in Atlanta and in other countries. They are working to set up an effective surveillance system so we know where the disease is (and is not): this is the most critical first step in outbreak control. They are implementing other tried and true public health disease control measures capable of bringing this virus to heel. Others at CDC are refining detailed guidance for US healthcare providers, laboratories, and public health so we know just how to evaluate and manage ill travelers from the affected areas who might have Ebola.

To paraphrase Albert Camus from his 1947 novel The Plague: what we learn in time of pestilence is that there is more to admire about man than to despise. Dr. Kent Brantly and Nancy Writebol are two admirable American volunteers among those who refused to abandon the sick and dying, knowing they risked their lives by doing so.

I have read that Dr. Brantly, whose faith led him to serve the Liberian people in the mission hospital well before Ebola emerged, has told friends that his decision to stay with his Ebola patients was inspired by three young Hebrew boys described in the book of Daniel. When faced with the demand to abandon their commitment to God or endure death by fire, they replied to the Babylonian King: “If we are thrown into the blazing furnace, the God we serve is able to save us from it, and he will rescue us from your hand, O king. But even if he does not, we want you to know, O king, that we will not serve your gods or worship the image of gold you have set u
p.” (Daniel 3:16-18) Like his ancient Hebrew heroes, Dr. Brantly did not abandon his commitment in the fear of his own death.

I confess that I shed an indignant tear or two over the remarks of those who claimed, out of ignorance, that the US should not bring Dr. Brantly and Mrs. Writebol to Emory Hospital for expert care after all they had done. Ebola simply isn’t a threat to the US population. We know how to handle an Ebola patient safely at any modern hospital. Ignorance and fear need to be cured here, as in Africa, with good information to fight the rumors, and that’s part of my role in this outbreak.

We should not forget West Africa after these two American heroes leave the spotlight in triumphant health. As a former Epidemic Intelligence Service officer at the CDC, I know the CDC has at its disposal the resources, people, and outbreak know-how that is the envy of the world. I can tell you that public health folks, all the way down to your local health department, have been educating themselves and preparing to meet any need that could arise, however unlikely. This pestilence may yet be one of public health’s finest hours.

For the latest CDC information, visit: http://www.cdc.gov/vhf/ebola/

About Kelly L. Moore, MD, MPH

Dr. Moore is a public health physician specializing in preventive medicine who works to minimize the burden of preventable diseases by guiding the control of outbreaks and promoting the optimal use of vaccines.

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Health Savvy: Don’t Forget the Easy Things!

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You know the regimen of taking care of yourself: each day you avoid processed foods, eat modestly, enjoying fresh fruits, vegetables and fish or lean meats; you get your body moving at least 30 minutes 5 days a week; you watch your blood pressure and risk of diabetes; you get your mammograms, colonoscopies and Pap smears; you get a good night’s sleep each night and make sure your family does, too. Right. Creating the conditions for your health to thrive is practically a full time job.

What if there was something easy you could do that requires just a few minutes once a year? What if you could lower the chances of debilitating and life-threatening diseases without a second thought? What if insurance would likely foot the bill? As a specialist in preventive medicine and public health, I remind people daily of one of the easiest and most under-appreciated ways to stay healthy as we age: immunization.  Below are listed a few vaccines routinely recommended for all adult women (and men) at different points in life. For more details, you can visit www.vaccineinformation.org or www.cdc.gov/vaccines/adults

  1. Every woman, every year: Influenza (flu) vaccine. The only reliable way to cut your chances of catching the flu each season. How well it works depends on the season and on your immune system, but it’s inexpensive and widely available, so why not? It comes as a nasal spray, a short under-the-skin injection or a traditional injection: get whatever is convenient and appropriate for you. You cannot afford to get sick and spend a week in bed, or worse, so make this part of your annual self-care regimen. For efficiency, get any other vaccines you need at the same time.
  2. Every woman: Tetanus, diphtheria and pertussis booster (“Tdap”). We all need a vaccine against tetanus and diphtheria every 10 years. If you haven’t had a Tdap yet, don’t wait 10 years…go ahead and get it now. It provides added protection against pertussis, or whooping cough, which has been on the rise in recent years because (regrettably) neither vaccine nor illness provides long lasting immunity. It causes a miserable cough illness that lasts weeks in adults and life-threatening illness in newborns.
  3. Speaking of newborns…All pregnant women should get 2 vaccines during every pregnancy: flu vaccine and Tdap. Influenza during pregnancy can be especially severe, and newborns can catch deadly pertussis from mom or others. By vaccinating during pregnancy, mom’s body shares her protective antibodies with her unborn child, helping protect baby in the earliest weeks of life.
  4. All women through 26 years: Human Papillomavirus vaccine (HPV). This vaccine prevents infection with strains of HPV that cause 70% of cervical cancer and other types of cancers in men and women. It’s routinely given to preteens, but this vaccine is essential cancer prevention for any woman under 27 who hasn’t had it yet.
  5. All women 60 and up: Shingles (zoster) vaccine. Anyone who has had chickenpox can come down with shingles, a painful rash that develops from reactivation of the chickenpox virus inside a nerve. If you are 60 or older, your chances of coming down with it are 1 in 3. The shingles vaccine, given just once to everyone over 60, can cut that to 1 in 6. If you do get shingles anyway, you’ll be much less likely to experience the debilitating pain some sufferers endure for months.
  6. All women 65 and up (and some earlier): pneumococcal vaccine. The “pneumonia shot” is recommended once after turning 65, but watch this space! New recommendations for additional protection may be coming very soon.

This list just hits the highlights of routine vaccines. You may need others because of your health. The Affordable Care Act (ACA) requires your insurance plan to charge no deductible or co-pay if you receive them from an in-network provider. Coverage is a bit more complicated under Medicare, TennCare and “grandfathered” plans not yet subject to ACA. Ask your healthcare provider, insurance plan or pharmacist to see what your benefits are. The savvy woman doesn’t pass up the chance to optimize her health.

About Kelly L. Moore, MD, MPH

Dr. Moore is a public health physician, with a specialty in preventive medicine, who works to minimize the burden of vaccine-preventable diseases.

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