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The Next 100 Years: Thoughts From the Field Natalie Bridger MD FRCPC DTM&H Kids Rock St. John’s, NL October 5, 2014.

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Presentation on theme: "The Next 100 Years: Thoughts From the Field Natalie Bridger MD FRCPC DTM&H Kids Rock St. John’s, NL October 5, 2014."— Presentation transcript:

1 The Next 100 Years: Thoughts From the Field Natalie Bridger MD FRCPC DTM&H Kids Rock St. John’s, NL October 5, 2014

2 Disclosures I have no conflicts of interest to declare All clinical photographs are originals and verbal consent was obtained prior to taking them I am not a fortune teller

3 The Past 100 Years… N Engl J Med 2012; 366:2333-2338

4 Objectives By the end of this presentation, the listener will be able to: – Discuss improvements in public health over the years – Recall some of the current public health challenges from a global and local perspective – Recognize (hopefully) that our combined efforts are necessary to ensure continued advances in the next 100 years

5 Case 1 10 year old girl from rural Haiti Brought to HBM after a 9 hour journey History of facial spasms followed by body spasms Also profuse drooling Fever Irritability

6 Case 1 (cont’d) History of stepping on sharp piece of wood 2 weeks ago Unvaccinated Puncture wound obvious on left foot with purulent drainage What is your diagnosis?

7 You’re Some Smart!

8 All in a weeks work … Premature infants – A/B’s – Poor weight gain – RDS – Sepsis – jaundice Neonatal sepsis Asthma Bronchiolitis Intussusception Bloody diarrhea Pneumonia Congenital hip dysplasia Skull fracture secondary to NAI Hydrocephalus GI obstruction VP shunt infections Severe dehydration Malnutrition Meningitis TB ?retinoblastoma Burns Cleft lip/palate Neural tube defects Ingestions Severe wound infections Syphilis Malaria Seizures anemia


10 Positive Moments

11 A Present…

12 The Alphabet Soup of Emerging Diseases MERS-Cov H7N9 SARS All the “E”s – Ebola – Enterovirus D68

13 Ebola Virus Member of filoviridae Enveloped, negative-stranded RNA virus 5 subtypes, 4 have caused human disease Reservoir and initial transmission not fully understood – Most likely reservoir fruit bats – Fruit bats may infect other animals – Humans acquire from eating poorly cooked animals or handling raw meat (bushmeat)

14 Ebola Epi First case 1976 20 subsequent outbreaks in Africa (<1000 deaths) Mortality rate 30-90% 2014 outbreak began January 2014 West Africa – Guinea – Sierra Leone – Liberia – Senegal – Nigeria – DRC (not connected to outbreak in above countries)

15 Transmission Human to human – Direct contact with secretions/excretions infected persons/cadavers – No documented airborne spread – Virus enters host through mucosal surfaces/skin breaks/parenterally – Asymptomatic persons in incubation period do not transmit!

16 Clinical Manifestations Incubation period 2-21 days (mean 4-10) Initially flulike illness: – Fever – Headache – Malaise – Myalgia – Sore throat – GI symptoms – Rash/conjunctival injection Hemorrhagic manifestations toward end of first week

17 Diagnosis RT-PCR (definitive) Ancillary: – Leukopenia – Lymphopenia – Atypical lymphocytosis – AST/ALP may be elevated – High PT, PTT

18 Treatment Supportive Experimental tx: – Monoclonal Abs – Ebola convalescent plasma – Immunization – Unknown safety and efficacy

19 What we don ’ t want

20 What we really don ’ t want…

21 What we really really don’t want

22 Meanwhile back home…

23 Meanwhile, back home…

24 Meanwhile back home…

25 If only everyone were as eager…

26 Meanwhile back home…




30 But it’s not just Jennie…

31 So… We have looked at diseases causing morbidity/mortality from the past We have discussed some of the health challenges of the present on a local and global scale We have discussed some simple measures to help mitigate current challenges Routine practices need to be ROUTINE!!! Business is booming

32 The Future’s So Bright I Gotta Wear Shades?… (and not because the ozone is depleted) In North America we have seen significant improvements in health indicators over past 100 years Vigilance is required by all of us to ensure we do not revert to pre-antibiotic, pre-vaccine era Developing countries need basic public health infrastructure to combat current challenges

33 Before and After Questions?

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