Emerging pandemics require ‘high degree of alertness’

San Diego-A number of emerging infectious diseases have made recent headlines-most prominently, the Ebola virus outbreak in West Africa-prompting higher levels of vigilance, said Paul Tambyah, MD, PhD, Singapore.

Though few of these diseases have directly had an impact on the eye, there have been a number of outbreaks of eye infections in recent years.

These include the global outbreak of Fusarium keratitis associated with contact lens use and smaller outbreaks of microsporidial and Acanthamoeba keratitis, said Dr. Tambyah in a keynote lecture during World Cornea Congress VII preceding the 2015 meeting of the American Society of Cataract and Refractive Surgery.

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The problem was not so much contamination, but that the contact lens solution was unable to prevent the growth of the fungal organisms,

As an infectious disease specialist, Dr. Tambyah discussed the case of a 24-year-old pig chaser with lymphocytic meningitis who was treated/released after 10 days. That patient became the first identified with Nipah virus.

Changes in the agriculture in Asia left the bats that carry the disease with nowhere to go, and hence the “endemic you’ve never heard of,” Dr. Tambyah said.

A pandemic has to be a novel virus (preferably from an animal), must cause harm to humans, and must be able to pass from humans to humans, and must, at its core, be able to cross species.

Next: SARS

Asia has been the center of several pandemics in recent years. The epidemic in Singapore (SARS) “began pretty small. Three women returned to Singapore after a trip to Hong Kong, were ill, and one woman was considered a ‘super spreader,’ responsible for 20 patients alone,” he said.

Systemic viral infections can present with acute keratoconjunctivitis-most notably, influenza virus infections including novel strains of avian influenza.

Responding to emerging pandemics requires a high degree of alertness to unusual presentations of ocular infections together with close integration with infectious diseases and public health colleagues, Dr. Tambyah said. He noted some of his earlier work crossed international boundaries as his group worked with the U.S. Center for Disease Control and European agencies as well.

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Without accurate and validated laboratory diagnoses, clinicians are often dependent on epidemiological and clinical clues.

“This is where public-health-surveillance systems are critically important in order that we can know the baseline rates of endemic infections so that we can recognize epidemics when they occur,” Dr. Tambyah said.

The recent H1N1 outbreak of 2009 was not, as it turned out, pigs or birds, but a disco-and everyone who had gotten ill in Singapore had been in contact with a sick bartender at a popular bar.

Treatment of novel infections is also a challenge, as there are “few approved therapies for ocular infections and novel therapeutics would take a long time to develop,” he added.

The current approach to pharmaceutical drug development does not encourage the development and stockpiling of drugs for rare diseases or those that are potential threats with small markets.

Apart from major militaries, many infections in tropical countries have a very small range of therapeutic options. In Singapore, the military has a much larger budget to be able to afford prophylactic medications. In Africa, however, ring prophylaxis (coupled with a $1,000 incentive) seemed to be successful in diminishing influenza.

Next: Conclusion

“Novel strains of influenza from China is a direct result of the country’s rapid adaptation of chicken consumption,” he said. But bats, as the only flying mammal, are largely responsible for the rapid deployment of some of these pandemic diseases.

Researchers and clinicians “must work together, get good data, and watch out for bats,” Dr. Tambyah said.