Eyeworld Daily News

EW SHOW DAILY 42 Meeting Reporter Saturday, April 18, 2015 by Lauren Lipuma EyeWorld Staff Writer F ew things hit headlines more prominently than outbreaks of disease. Whether it's a novel virus, a disease that resurfaces after being controlled for decades, or an infection that becomes resistant to the available drugs, an emerging infectious disease has the potential to wreak havoc both locally and globally. Ophthalmology is not complet- ed insulated from this problem— although emerging infections are systemic, they often have eye-related symptoms. Systemic viral infections, especially influenza, often present with acute keratoconjunctivitis. In addition, outbreaks of ocular infections do occur—2005 and 2006 saw a global outbreak of Fusarium keratitis associated with a contact lens solution. Treating disease outbreaks is challenging, but physicians and public health officials have a host of strategies in their armamentarium. Infectious disease specialist Paul Tambyah, MD, Singapore, outlined some of the strategies that have been successful in controlling past global outbreaks in his presentation, "Emerging Pandemics," the keynote address of Friday's "World Health and Eye Banking" session. Where do outbreaks originate? Southeast Asia has been the epicen- ter of many emerging infections in recent years, and as a physician from Singapore, Dr. Tambyah has been on the front lines of tackling them, from outbreaks of severe acute respi- ratory syndrome (SARS) to influenza strains and even the novel Nipah virus that was basis of the movie Contagion. Birds and bats are the natu- ral hosts for many emergent viral strains, with pigs serving as efficient vehicles for delivering them to humans. With huge concentrations of people, pigs, chickens, and ducks, China has contributed greatly to the emergence of novel viral diseases, Dr. Tambyah said. "As China has advanced, the rate of poultry consumption has in- creased dramatically," he said. "They have reached the level of poultry consumption that took the United States almost 50 years to reach in just 10–15 years." With air travel from China reaching across the globe, the risk of local outbreaks reaching global epi- demic proportions is rising, sparking the need for innovative and effective control strategies. Modifying old methods for a new outbreak Different strategies arise for different outbreaks, and no 2 strategies are identical. What is clear is that being innovative and adaptive is critical to success when handling emerging pandemics. A previous strategy, when suc- cessful, may have to be modified to meet the needs of a new outbreak. During the 2009 H1N1 influenza outbreak, Singapore took an initial quarantine approach, but quickly realized that this strategy wouldn't work for the 30,000 members of its military. Officials then considered complete chemoprophylaxis— vaccinating all active military per- sonnel with oseltamivir (Tamiflu, Genentech, South San Francisco). Military leaders quickly realized that this strategy had a major flaw. Oseltamivir can lead to neuropsy- chiatric side effects in 1 in 10,000 in- dividuals. With 30,000 troops, they didn't want to risk the possibility of 3 soldiers carrying weapons expe- riencing delirium, hallucinations, confusion, or abnormal behavior. Officials finally settled on a modified ring vaccination strategy— and it worked. Ring vaccinations— tracking down infected individuals and vaccinating those around them—were extremely successful in controlling smallpox and played a crucial role in its eradication in 1977. By adopting this strategy, the Singaporean military was able to shorten the outbreak by 2 days with- out having to quarantine anyone or adversely affect the military's day-to- day functioning. The big picture Responding to emerging pandemics requires physicians to be extremely alert to unusual presentations of infections, Dr. Tambyah said, and to have excellent communication with infectious diseases and public health colleagues. Being innovative and adaptive is critical to success when handling emerging pandemics, but preven- tion is really the key, Dr. Tambyah said. Clinicians need to be aware of emerging infectious disease trends to protect themselves, their staff, and their patients. While the initial approach may be to overreact, especially for dangerous pathogens, he said, a sustainable and practical approach will ensure good outcomes for patients and for global public health. EW Editors' note: Dr. Tambyah has no financial interests related to this article. Innovative strategies are effective in treating emerging pandemics Dr. Tambyah explains how increased poultry consumption in China has fueled outbreaks of zoonotic infections. 'World Health and Eye Banking' I n addition to Dr. Tambyah's keynote address, "Emerging Pandemics," these physicians spoke on the following topics: • Monty M. Montoya, MBA, Seattle, spoke on "Eye Banking in Evolution: Role of the MD." • Maria A. Woodward, MD, Ann Arbor, Mich., spoke on "Cornea Surgery Begins in the Eye Bank Tissue Preparation." • Matt Oliva, MD, Medford, Ore., spoke on "Nonstandard Uses of Corneal Tissue in the Developing World." • Keryn A. Williams, PhD, Adelaide, Australia, spoke on "Corneal Graft Registries." • Patricia Dahl, CEO, New York, spoke on "Emergency Disaster Preparedness." • Col. Keith J. Wroblewski, MD, Bethesda, Md., spoke on "Chemical and Biological Warfare." • Col. Anthony J. Johnson, MD, San Antonio, Texas, spoke on "Managing War Trauma." • Naoshi Shinozaki, Tokyo, spoke on "Nuclear Fall Out." EW

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