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January 12, 2012 at 11:42 pm By Roz Potter
From Maryn McKenna’s blog, Superbug, at Wired.com, Link
Tuberculosis is one of the world’s most lethal communicable diseases, accounting for 9.4 million cases and 1.7 million deaths in 2009, according to the World Health Organization. That death toll may soon be much higher.
Due to incomplete and incorrect treatment regimens, the bacteria has developed resistance to all drugs known to effectively treat it, according to a group of doctors in Mumbai, India.
The World Health Organization takes issue with the notion that the bacteria is totally drug-resistant, or TDR, since experimental drugs have not yet been tried.
Excerpts:
News of some of the cases was published Dec. 21 in an ahead-of-print letter to the journal Clinical Infectious Diseases…
On Saturday, the Times of India disclosed that there are actually 12 known cases just in one hospital, the P. D. Hinduja National Hospital and Medical Research Centre; in the article, Hinduja’s Dr. Amita Athawale admits, “The cases we clinically isolate are just the tip of the iceberg.” And as a followup, the Hindustan Times reported yesterday that most hospitals in the city — by extension, most Indian cities — don’t have the facilities to identify the TDR strain, making it more likely that unrecognized cases can go on to infect others.
***
Because of the mismatch between treatment and symptoms, people often don’t take their full course of drugs — and from that (and some other factors I’ll talk about in a minute) we get multi-drug resistant and extensively drug-resistant, MDR and XDR, TB. MDR is resistant to the first-choice drugs, requiring that patients instead be treated with a larger cocktail of “second-line” agents, which are less effective, have more side effects, and take much longer to effect a cure, sometimes 2 years or more. XDR is resistant to the three first-line drugs and several of the nine or so drugs usually recognized as being second choice.
***
As of last spring, according to the WHO, there were about 440,000 cases of MDR-TB per year, accounting for 150,000 deaths, and 25,000 cases of XDR. At the time, the WHO predicted there would be 2 million MDR or XDR cases in the word by 2012.
That was before TDR-TB.
The first cases, as it turns out, were not these Indian ones, but an equally under-reported cluster of 15 patients in Iran in 2009. They were embedded in a larger outbreak of 146 cases of MDR-TB, and what most worried the physicians who saw them was that the drug resistance was occurring in immigrants and cross-border migrants as well as Iranians: Half of the patients were Iranian, and the rest Afghan, Azerbaijani and Iraqi. The Iranian team raised the possibility at the time that rates of TDR were higher than they knew, especially in border areas where there would be little diagnostic capacity or even basic medical care.
The Indian cases disclosed before Christmas demonstrate what happens when TB patients don’t get good medical care. The letter to CID describes the course of four of the 12 patients; all four saw two to four doctors during their illness, and at least three got multiple, partial courses of the wrong antibiotics. The authors say this is not unusual:
Posted in Drug Resistant Microorganisms, Infectious and Communicable Disease | No Comments »
December 20, 2011 at 12:51 pm By Roz Potter
From the Independent: Link
Excerpts:
A deadly strain of bird flu with the potential to infect and kill millions of people has been created in a laboratory by European scientists – who now want to publish full details of how they did it.
***
For the first time the researchers have been able to mutate the H5N1 strain of avian influenza so that it can be transmitted easily through the air in coughs and sneezes. Until now, it was thought that H5N1 bird flu could only be transmitted between humans via very close physical contact.
***
What makes H5N1 so dangerous, though, is that it has killed about 60 per cent of those it has infected, making it one of the most lethal known forms of influenza in modern history – a deadliness moderated only by its inability (so far) to spread easily through airborne water droplets.
***
The details of the study are so sensitive that they are being scrutinised by the US Government’s own National Science Advisory Board for Biosecurity, which is understood to have advised American officials that key parts of the scientific paper should be redacted to prevent terrorists from using the information to reverse-engineer their own lethal strain of flu virus.
***
Some scientists have privately questioned whether such research should have been done in a university department that does not have the sophisticated anti-terrorist security of a military facility. They also point out that experimental viruses kept in seemingly secure laboratories have escaped in the past to cause human epidemics – such as a 1977 flu outbreak.
“There are people who say that the work should never have been done, or if it was done it should have been done in a setting where the information could be better controlled,” said the source close to the biosecurity board.
***
The study was carried out by a Dutch team of scientists led by Ron Fouchier of the Erasmus Medical Centre in Rotterdam, where the mutated virus is stored under lock and key, but without armed guards, in a basement building.
Dr Fouchier, who declined to answer questions until a decision is made on publication, said in a statement released on the university’s website that it only took a small number of mutations to change the avian flu virus into a form that could spread more easily between humans.
Posted in Infectious and Communicable Disease, Pandemic Flu | No Comments »
November 5, 2011 at 11:02 pm By Roz Potter
From Dr. Tara Smith’s Aetiology blog, Link
Some parents are exposing their children to the body fluids of other people’s children to purposefully cause chickenpox, measles and other serious viral diseases.
Facebook is used to hook up parents who have infected children, with parents who want their uninfected and unvaccinated children to acquire these diseases naturally. Participating parents mistakenly believe that vaccinations cause autism.
The US Mail is used to send the contaminated lollipops and other treats.
Please check out the link above, and its CBS news video, to learn more.
Posted in Child Health, Child Safety, Infectious and Communicable Disease | No Comments »
September 29, 2011 at 8:03 pm By Roz Potter
From Maryn McKenna’s blog on Wired.com: Link
We refrigerate food so we don’t get sick. But in the case of the bacterium Listeria monocytogenes, refrigeration doesn’t help because unlike most other bacteria, Listeria reproduces well in cold temperatures.
Excerpts:
An outbreak of foodborne illness that appears to be spread by fresh cantaloupes has sickened 72 people so far, in 18 states, and 13 have died. According to investigators, the source of the contamination has not yet been found. And also, according to a media briefing today, the contaminated cantaloupes were also shipped overseas, to countries that investigators would not identify.
And, as an extra bonus, the tally of cases and deaths is likely to keep rising, because the particular illness in this outbreak has an incubation period of up to two months
The outbreak, which has been building for several weeks, involves melons from a single grower in Granada, Colo. called Jensen Farms. The first cases occurred at the beginning of August and authorities began to be concerned when the outbreak crossed state lines in early September. On Sept. 14, the growers did the right thing and launched a recall of all the whole cantaloupes they shipped between July 29 and Sept. 10. To their knowledge, they had sold cantaloupes to wholesalers and distributors in 17 25 states.
At this point, I can practically hear foodborne-disease geeks — as well as almost anyone who has taken a tropical vacation — thinking to themselves: “Wait. Weren’t we told it’s safe to eat fruit if it has a rind and you don’t eat the rind? You don’t eat cantaloupe rind. What gives?” And that’s correct, generally.
The advice you get, if you want to eat anything raw that might have been contaminated, is to choose something with a peel, wash it, and then peel it yourself. But there’s an aspect of melon that makes this problematic: Unlike a banana, you don’t peel a melon with your fingers. You slice it, and the knife blade can carry any organisms on the outside of the melon into the flesh.
Posted in Food Safety, Infectious and Communicable Disease | No Comments »
September 13, 2011 at 11:23 pm By Roz Potter
From the Globe and Mail: Link
Tuberculosis is an airborne disease that knows no boundaries. It is spread person to person through air that is exhaled, coughed or sneezed by infected individuals. Exposed individuals who are very young, old, chronically ill or immunocompromised are at highest risk.
Excerpts:
“TB is an old disease that never went away, and now it is evolving with a vengeance,” said Zsuzsanna Jakab, the WHO’s Regional Director for Europe.
“The numbers are scary,” Lucica Ditiu, executive secretary of the Stop TB Partnership told a news conference in London. “This is a very dramatic situation.”
TB is currently a worldwide pandemic that kills around 1.7 million people a year. The infection is caused by the bacterium Mycobacterium tuberculosis and destroys patients’ lung tissue, causing them to cough up the bacteria, which then spreads through the air and can be inhaled by others.
Cases of multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) – where the infections are resistant to first-line and then second-line antibiotic treatments – are spreading fast, with about 440,000 new patients every year around the world.
Experts say around 7 per cent of patients with straightforward TB die, and that death rate rises to around 50 per cent of patients with drug-resistant forms.
According to the WHO and Stop TB, 15 of the 27 countries with the highest burden of MDR-TB are in the WHO’s European region, which includes 53 countries in Europe and Central Asia.
More than 80,000 MDR-TB cases occur in the region each year – almost a fifth of the world’s total. The WHO said precise figures for XDR-TB are not available because most countries lack the facilities to diagnose it, but officially reported cases of XDR-TB increased six-fold between 2008 and 2009.
Rates are highest in eastern Europe and Central Asia, but many countries in western Europe have increasing rates of TB and drug-resistant TB, Ditiu said. Britain’s capital, London, has the highest TB rate of any capital city in western Europe with around 3,500 cases a year, 2 per cent of which are MDR-TB.
Treating even normal TB is a long and unpleasant process, with patients needing to take a combination of powerful antibiotics for 6 months. Many patients fail to correctly complete the course of medicines, a factor which has fuelled a rise in drug-resistant forms of the disease.
Treatment regimes for MDR-TB and XDR-TB can stretch into two or more years, costing up to $16,000 in drugs alone and up to $200,000 to $300,000 per patient if isolation hospital costs, medical care and other resources are taken into account.
Posted in Emerging Infectious Diseases, Infectious and Communicable Disease | No Comments »
August 11, 2011 at 8:33 am By Roz Potter
From KevinMD.com, Link
Excerpt:
We tend to forget that these were (and are) serious illnesses. Call many of them the common diseases of childhood, but large numbers died of measles, and all too many lost their hearing even if treated promptly with antibiotics for Hemophilus meningitis.
Influenza still hospitalizes more than 100,000 Americans every year and leads to death in about 36,000 per year. At least 50% of flu cases could be prevented with vaccination – the key is to actually get vaccinated. The same can be said of polio. Americans tend to think of it as an eradicated disease but it still exists endemically in a few developing countries where vaccination has been either too expensive or thought to cause harm.
Do your kids need to be vaccinated now given that there are no cases in the United States? Yes, because the virus is just a jet plane trip away. Right now measles is a significant problem. Most kids get vaccinated and schools require proof of vaccination for entry.
But some kids do not get vaccinated, especially home schooled children. And that proved to be a serious problem a few years ago when a homeschooled, unvaccinated teenager came back from a vacation in Romania in the prodrome of measles. She went to a church function on the weekend mingling with about 500 people including many other unvaccinated children. Thirty four individuals developed measles, 12 of whom needed hospitalization and one nearly died. Measles is simply not a “minor” childhood infection of little import. Nor are the others that can be prevented today with vaccination.
Posted in Child Health, Infectious and Communicable Disease | No Comments »
July 20, 2011 at 11:58 am By Roz Potter
From the CDC, (Centers for Disease Control and Prevention), Link
- Map of Dengue Fever distribution in the western hemisphere
Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas
This is an official CDC HEALTH ADVISORY
Summary
Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF).
The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas–both domestic and abroad–who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.
Background
Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean.
This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific.
With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler. The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.
Symptoms
Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF.
DF is a self-limited febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel.
Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence.
A small proportion of patients develop DHF, which is characterized by presence of resolving fever or a recent history of fever, lasting 27 days, any hemorrhagic manifestation, thrombocytopenia (platelet count ≤100,000/mm3), and increased vascular permeability, evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock.
Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids. There is no antiviral drug or vaccine against the dengue virus. Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf
- Health care providers seeing patients with dengue-like illness who have recently traveled to Puerto Rico, Key West, Florida or international dengue-affected areas (See world distribution of dengue maps at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx) should report cases to the local or state health department and send specimens for laboratory testing.
- DF and DHF are now nationally notifiable conditions in the United States. Please remember that apart from individuals traveling for tourism, individuals responding to international disasters (e.g., Haiti earthquake), participating in medical or religious missionary work, and visiting friends and relatives are often returning from dengue-affected areas and should be evaluated for dengue infection if they present with dengue-like illness during or after their travel.
- Reporting to local public health officials and consideration of hospitalization to initiate supportive care should not be delayed pending test results. Reporting suspected dengue cases will trigger a public health investigation and the implementation of prevention measures.
- Specimens from patients with acute febrile illness, who returned from dengue-affected areas within the past 14 days, should be submitted to their local or state health department, if the health department laboratory offers dengue testing. State health departments with the capacity to test for dengue include: AZ, CA, CT, FL, NY, PR, and TX.
- If the local or state health department does not perform dengue testing, submit specimens directly to CDC laboratories in San Juan, Puerto Rico (address below). CDC offers free diagnostic testing for health care providers and confirmatory dengue testing for health department and private laboratories. A completed CDC Dengue Case Investigation Form (http://www.cdc.gov/Dengue/resources/DCIF_English_ColorSept1508_FINAL_.pdf) must accompany the specimens for the appropriate testing to be performed.
Whenever possible, submit paired acute and convalescent specimens (2 ml of centrifuged serum.) Accuracy is increased when both acute and convalescent specimens are available for testing. But providers should not wait and should submit acute specimens as soon as available; a convalescent specimen can be submitted when available.
| Type of sample |
Interval since onset of symptoms |
Type of Analysis |
| Acute |
until day 5 |
RT-PCR for dengue virus |
| Convalescent |
6 to 30 days |
ELISA for dengue IgM |
Centers for Disease Control and Prevention
Dengue Branch
1324 Cañada Street
San Juan, Puerto Rico 00920
Tel: (787) 706-2399; fax (787) 706-2496
For More Information:
- Call CDC’s toll-free information line, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day.
The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Posted in Emerging Infectious Diseases, Infectious and Communicable Disease | No Comments »
June 12, 2011 at 11:13 am By Roz Potter
From the NYT: Link
Excerpts:
The deaths of 31 people in Europe from a little-known strain of E. coli have raised alarms worldwide, but we shouldn’t be surprised. Our food often betrays us. (editor’s note: in Europe, more than 3283 people have confirmed cases and at least 100 of these need kidney transplants, due to severe damage to their kidneys from the Shiga toxin-producing bacteria. Many more who have been sickened are not in the official count, for a variety of reasons).
Just a few days ago, a 2-year-old girl in Dryden, Va., died in a hospital after suffering bloody diarrhea linked to another strain of E. coli. Her brother was also hospitalized but survived.
Every year in the United States, 325,000 people are hospitalized because of food-borne illnesses and 5,000 die, according to the Centers for Disease Control and Prevention. That’s right: food kills one person every two hours.
Yet while the terrorist attacks of 2001 led us to transform the way we approach national security, the deaths of almost twice as many people annually have still not generated basic food-safety initiatives. We have an industrial farming system that is a marvel for producing cheap food, but its lobbyists block initiatives to make food safer.
Perhaps the most disgraceful aspect of our agricultural system — I say this as an Oregon farmboy who once raised sheep, cattle and hogs — is the way antibiotics are recklessly stuffed into healthy animals to make them grow faster.
The Food and Drug Administration reported recently that 80 percent of antibiotics in the United States go to livestock, not humans. And 90 percent of the livestock antibiotics are administered in their food or water, typically to healthy animals to keep them from getting sick when they are confined in squalid and crowded conditions.
The single state of North Carolina uses more antibiotics for livestock than the entire United States uses for humans.
This cavalier use of low-level antibiotics creates a perfect breeding ground for antibiotic-resistant pathogens. The upshot is that ailments can become pretty much untreatable.
Posted in Drug Resistant Microorganisms, Emerging Infectious Diseases, Food Safety, Infectious and Communicable Disease | No Comments »
June 4, 2011 at 2:53 pm By Roz Potter
Sources:
World Health Organization update #6 Link
Center for Infectious Disease Research and Policy from the Univ of Minnesota: Link
June 2011 update from Eurosurveillance: Link
From H5N1 blog: a translation of an article from the German Ärzte Zeitung: EHEC: Early neurological therapy recommended, Link
Excerpts:
The count of cases (some severely ill with renal failure and serious neurological symptoms) and deaths in Europe’s Escherichia coli outbreak pushes higher daily, with official case counts of around 1700, with many others likely uncounted. The epidemic has been traced to Hamburg, Germany but the exact source remains unknown. Many who are infected attended a 2 day Festival in Hamburg.
A WHO expert, Donato Greco, told the Italian newspaper La Repubblica: “The virus is found in intestines of cattle and therefore usually in raw meat such as tartar or poorly cooked hamburgers.” He said he had never yet seen such dangerous intestinal bacteria on fruits and vegetables.
There are two types of infection, one,with fewer victims involves hemolytic uremic syndrome (HUS), or potentially fatal kidney failure. A number of victims are on dialysis.
*****
The German Society of Neurology (DGN) has reported that about half of patients with hemolytic-uremic syndrome (HUS) may also suffer from severe and sometimes irreversible neurological disorders.
Two Hamburg neurologists, Professor Joachim Roether and Professor Christian Gerloff, say that is is alarming that the neurological condition in spite of early plasmapheresis does not improve or even deteriorates.
Gerloff is director of neurology at the University Hospital Hamburg-Eppendorf (UKE), Roether is Chief of Neurology at the Asklepios Clinic Altona.
Espeically striking is the early appearance of neurological symptoms, says Gerloff. “It can develop simultaneously with renal and gastroenterological symptoms.”
Crucial features of HUS are bloody diarrhea, hemolysis, and renal dysfunction. In the neurological symptom complex in HUS, the first are confusion, reduced vigilance, irritability and delirium. There are also many cases of aphasia and apraxia, and disturbances of the brain stem functions. In severe cases, patients develop myoclonic seizures and sometimes that can lead to coma.
Posted in Drug Resistant Microorganisms, Emerging Infectious Diseases, Health, Infection Prevention and Control, Infectious and Communicable Disease | No Comments »
January 4, 2011 at 12:02 am By Roz Potter
No, this is not a statement from the 2010 pandemic. It is from a news story dated 1/4/11 and reflects the current swine flu (H1N1) epidemic in England. Doctor’s say the illness is more severe this year than last. Flu cases are also rising in the U.S. See link.
If you haven’t yet been vaccinated, now’s the time. It takes weeks to develop immunity after vaccination.
Posted in Infectious and Communicable Disease, Pandemic Flu | No Comments »
Of Note