[Health] The Infectious Diseases Thread

[Smoove_B]

I have no sympathy as long as it's a reasonable policy with a scientific justification. You can't quarantine everyone, but a medical worker who was exposed? Yes.

The New England Journal of Medicine came out strongly against the NY/NJ protocols, but I disagree with their position. I can appreciate that we want to encourage and respect selfless individuals that go over to help in any way, but to allow them to then come back and freely mix with random people after having direct contact with Ebola patients is insanity. While quarantine might seem severe, it's really our only legally tested tool (along with isolation) to address these types of issues. Of course it makes more sense to have specific travel protocols in place with detailed information regarding screening, temperature checks and evaluations but to expect all the States to create these policies and somehow equally enforce them is madness.

The position of the NEJM seems to be more political in nature - that is, we need to stop focusing on workers returning from impacted countries and rather throw all of our attention at stopping the outbreak at the source. Well...yeah. But when you end up crippling state and local public health departments and ER services because of fear over disease, we need to step up. When the Texas Supreme Court officially recognizes the importance of considering the needs of the many, perhaps we should all take note.

Really, the issue is that no one has any idea what's going on (federally, state, local) and everyone is grasping for straws. This is exactly what happened with Anthrax and you would sort have assumed we learned from that horrific experience in the Fall of 2001...but apparently not.

[RunningMn9]

While quarantine might seem severe, it's really our only legally tested tool (along with isolation) to address these types of issues. Of course it makes more sense to have specific travel protocols in place with detailed information regarding screening, temperature checks and evaluations but to expect all the States to create these policies and somehow equally enforce them is madness.

I think the issue is with how/why the quarantine was handled. If it was "As a medical professional that has recently taken on a significant risk to your own health to help contain this ebola outbreak, we hope you understand that we are going to quarantine you when you re-enter the country - here let us make this as comfortable as possible for you to thank you for what you are doing..." sort of thing, maybe it would be cool with everyone.

Instead, we went with "ZOMG!! FEAR TEH EBOLAS!!! QUARANTINE!!!! WITCH!!!!" - which was less cool with some people.

[Smoove_B]

That's part of it, but I think the bigger issue for objectors is that you run the risk of discouraging people up front from volunteering their skills and abilities to help deal with this. I would imagine if someone is working a F/T job and they are taking vacation time or given permission by their employer to travel to Africa for a week (or two) in order to help, being told that when they return home they'll need to sit in their house for 21 days after last patient contact -- at their own expense -- it will stop people from caring and looking to offer aid.

When we order someone into quarantine or isolation it's on us to provide for them. We're apparently asking for "voluntary quarantine" with the hopes that people will just end up doing the right thing - at their own expense. I'm waiting for someone to figure out that our Governor ordered that quarantine on a person without an official State of Emergency being declared - he used powers that are only given to him under the NJ Emergency Heath Powers Act of 2005. I'm sure lawyers are frothing at the mouth looking to take a crack at this nurse's case.

[RunningMn9]

That's part of it, but I think the bigger issue for objectors is that you run the risk of discouraging people up front from volunteering their skills and abilities to help deal with this.

That's what I mean. If they were making this quarantine easy on people - it would be easier to tolerate. Making it more difficult will make it less likely for people to volunteer - which ultimately makes it harder to do the most important task - which is halt the actual outbreak.

[Zaxxon]

Shift-? shows keyboard shortcuts. # will immediately trash the focused conversation.

[Blackhawk]

Shift-? shows keyboard shortcuts. # will immediately trash the focused conversation.

Ebola Inbox?

[RunningMn9]

Shift-? shows keyboard shortcuts. # will immediately trash the focused conversation.

[Zaxxon]

Whups!

[Jeff V]

If ebola is infecting your inbox, it should definitely be quarantined. That's what AV programs are for.

[Smoove_B]

Oh, how you all laughed when I warned you about the semen. Well, who's laughing now?

At the Delhi airport, the 26-year-old immediately told officials his medical history: He was successfully treated for Ebola in Liberia and released from a health facility back in late September. When he boarded the plane, he had no symptoms.

The man's blood tested negative for Ebola, three times at the airport. But the virus was still lingering in one bodily fluid — his semen, health officials said.

That's not a surprise. Doctors have known for decades that the Ebola virus persists in semen for months after a person recovers from the disease.

"That's because antibodies produced in the bloodstream don't reach the testicles," said Marie-Christine Ferir, an emergency coordinator for Doctors Without Borders, based in Brussels.

[Z-Corn]

Another good reason to make sure you "Get The Poison Out" everyday...

[$iljanus]

Oh, how you all laughed when I warned you about the semen. Well, who's laughing now?

At the Delhi airport, the 26-year-old immediately told officials his medical history: He was successfully treated for Ebola in Liberia and released from a health facility back in late September. When he boarded the plane, he had no symptoms.

The man's blood tested negative for Ebola, three times at the airport. But the virus was still lingering in one bodily fluid — his semen, health officials said.

That's not a surprise. Doctors have known for decades that the Ebola virus persists in semen for months after a person recovers from the disease.

"That's because antibodies produced in the bloodstream don't reach the testicles," said Marie-Christine Ferir, an emergency coordinator for Doctors Without Borders, based in Brussels.

Wise words of warning indeed. And sig worthy, I dare say.

[Smoove_B]

I've made it my goal for 2015 to work this into numerous conversations:

That's because antibodies produced in the bloodstream don't reach the testicles,

It's just so...awesome.

[Isgrimnur]

HIV getting weaker

The team at the University of Oxford has shown that it was taking longer for HIV infection to cause AIDS.

The rapid evolution of HIV, which has allowed the virus to develop resistance to patients' natural immunity is at the same time slowing the virus's ability to cause AIDS.

The study also indicates that people infected by HIV are likely to progress to AIDS more slowly — in other words the virus becomes less virulent — because of widespread access to antiretroviral therapy (ART). Both processes make an important contribution to the overall goal of the control and eradication of the HIV epidemic.

[AWS260]

Remind me never to get Ebola.

An Ebola Doctor’s Return From the Edge of Death

His temperature was 104 degrees. His hands shook violently. He spent more and more time sleeping, and sank into delirium, his mind still in Kenema.

The family had been warned that Ebola often causes such intense diarrhea that patients can lose eight or 10 quarts of fluid a day, and Dr. Crozier was heading toward that stage. He would be pumped full of fluids and salts to prevent dehydration, which kills many Ebola patients. The family thought that once he got through that phase, he would start to improve.

Instead he got worse. By Friday he was struggling to breathe, his chest heaving. The sight tore at his relatives. On Sunday morning, he was placed on a ventilator.

[AWS260]

TIME's person of the year: the Ebola fighters. A good choice.

[Isgrimnur]

Watch those caramel apples.

Health officials are warning consumers to avoid eating caramel apples after linking the fall treats to a multi-state listeria outbreak that has been linked to at least four deaths.

Officials from the U.S. Centers of Disease Control and Prevention reported today that at least 28 people from 10 states, including Minnesota, Arizona and Texas, have been infected with Listeriosis due to Listeria monocytogenes, a bacteria that can cause life-threatening illness.

Of those infected, five died and Listeriosis definitely contributed to at least four deaths, according to the CDC.

Out of an abundance of caution, the CDC warned all consumers to avoid eating prepackaged caramel apples while they investigate the outbreak alongside the U.S. Food and Drug Administration and state health organizations.

The outbreak reported today has infected people across a wide swath of the U.S. from North Carolina to California and across a large age range from ages 7 to 92, according to the CDC.
...
Bill Marler, a food safety lawyer based in Seattle, said listeria can be a particularly difficult bacteria to control because its growth is not inhibited by refrigeration.

“I can see caramel apples sitting in your refrigerator for a long time,” he said. “Listeria has evolved and it has evolved to grow really well at refrigerated temperatures.”
...
Those sickened in Minnesota bought caramel apples from Cub Foods, Kwik Trip and Mike’s Discount Foods, which carried the Carnival and Kitchen Cravings brand of caramel apples, according to the Minnesota Department of Health.

The apples are no longer being carried in stores because they are a seasonal item.

[J.D.]

The apples are no longer being carried in stores because they are a seasonal item.

Problem solved.

[Smoove_B]

Problem solved.

With the potential for a ~60 day incubation period, this could be going on a while and it's likely there is still product out on the shelves (no recall has been issued) and in people's homes. Did you want to talk about Listeriosis or were you just making chit-chat?

[J.D.]

Honestly, all I know about Listeriosis is that my wife wouldn't eat cold cuts while pregnant because of it.

[Smoove_B]

Good to hear she was given that message. Cold cuts, soft cheeses and hot dogs -- those were the traditional foods we were told to avoid for Listeria. Now...it's showing up in weird places - like Cantaloupe and Caramel Apples.

Other random fact about Listeria -- it's a psychrophile (that's for Isg) - and why it's always part of that "except sometimes..." when you're talking about the temperature danger zone for food safety.

[Isgrimnur]

Cryophile is an easier word to parse.

[Smoove_B]

20+ years later, you remember what you were taught. Plus, I like saying "Psycrophilic Listeria monocytogenes." It sounds like you're speaking gibberish.

[Jeff V]

Fun fact of the day: After John Riccitello left Sara Lee Bakery to become COO at Electronic Arts, the Bakery division was internally merged and managed by the CEO of Bilmar Foods, a hot dog and lunchmeat division. A few months later, Bilmar had their hands full when around a dozen people died from their listeria dogs.

Well, not so fun I guess if you were one of the victims. Prior to this, I was caught in the contractor purge that followed this consolidation and was kicked to the curb after 2 years of unappreciated toil.

[LawBeefaroni]

Happy Holidays, kid! Welcome to the States.

CHICAGO (WLS) -- A child was admitted to University of Chicago Medical Center for observation to rule out the Ebola virus early Friday morning after authorities found the patient had a fever, but no other Ebola symptoms, during a screening at O'Hare International Airport.

The child is quarantined in accordance with strict protocols as doctors observe his or her condition.

United Airlines plane flight No. 959, carrying 173 passengers, came in from London into O'Hare Friday night. On the flight was a child with a fever.

Not that I disagree with the precaution but damn, that sucks for him/her.

[Isgrimnur]

This evening's random image comes to us courtesy of NPR.



Context will only ruin it, but here you go:

Spoiler:

Viruses can spread through the air in two ways: inside large droplets that fall quickly to the ground (red), or inside tiny droplets that float in the air (gray). In the first route, called droplet transmission, the virus can spread only about 3 to 6 feet from an infected person. In the second route, called airborne transmission, the virus can travel 30 feet or more.

[J.D.]

The flu virus has arrived here in Southern Ontario. My kid has it. Two of my friends' kids have it. My son's hockey team is decimated by it. And my brother-in-law who is an ER doc says the waiting rooms have been jammed all week with people having flu-like symptoms.

[BooTx]

Yeah tis the season. Flu and norovirus are running rampant here in mid-Michigan right now. If you don't want it I strongly advise you to wash / sanitize your hands every time you touch something in public.

And stay away from children. They're all diseased.

[Isgrimnur]

New antibiotic

In the fight against infectious bacteria, humans are slowly losing the battle. That’s because common pathogens are developing resistance to the antibiotics we use to wipe them out. By 2050 it’s expected that, globally, drug-resistant infections will kill more people than cancer.

However, the fight is far from over. Researchers have discovered a potential new class of antibiotic that’s a triple threat: it obliterates many types of drug-resistant bacteria, it’s safe in mammals, and enemy cells weren’t easily able to develop resistance to it. And the microbes that produce it were discovered in the soil of one of the study authors’ backyards.
...
Teixobactin wages an attack against the cell walls of targeted bacteria to kill them. It’s the same method of extermination used by another antibiotic called vancomycin, which was discovered in 1953. Vancomycin was an old stand-by, but bacteria resistant to vancomycin eventually emerged about 40 years after its discovery. However, the specific way teixobactin attacks its enemies’ cell walls led researchers to believe it’s unlikely that bacteria will develop resistance to teixobactin in 40 years — if at all.

As encouraging as teixobactin was in the petri dish, the true test was whether it could perform safely in an animal. Researchers gave mice a nearly fatal infection of a drug-resistant form of MRSA (methicillin-resistant Staphylococcus aureus). An hour after infection, they injected mice with a dose of teixobactin, and every single treated mouse survived. Researchers published their findings Wednesday in the journal Nature.
...
[R]esearchers’ new method of growing and studying previously unculturable soil bacteria is a new twist that could reignite the search for novel antibiotics. In fact, researchers believe there are many more antimicrobial candidates hidden in the dirt.

[Isgrimnur]

Most Healthcare-related infections statistics down

Rates of most major types of healthcare-associated infections have declined markedly in recent years, the CDC said Wednesday, although the trend did not extend to catheter-associated urinary tract infections.

In 2013, significant decreases in standardized infection rates were seen for central line-associated bloodstream infections (down 46% from 2008), surgical site infections (down 19% from 2008), hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) infections (down 8% from 2011), and hospital-onset Clostridium difficile infections (down 10% from 2011), according to the National and State Healthcare-Associated Infections Progress Report.

But catheter-associated urinary tract infections had a 6% uptick from 2009 to 2013, the report said. On the other hand, "initial data seem to indicate that these infections have started to decrease."
...
In addition to the national summary, the report also included state-by-state data (including the District of Columbia and Puerto Rico) on the major classes of healthcare-associated infection, for which the picture was more mixed.

Some states saw massive increases in certain types of infection -- a 42% increase in rates of MRSA bacteremia in Alabama, for example -- while others showed dramatic declines, such as Louisiana's decrease of 37% in C. difficile.

[Isgrimnur]

Pills to treat C. difficile

This year researchers developed a less cringe-inducing alternative. They created odorless frozen capsules that contained bacteria isolated from healthy stool samples. The poo pills successfully treated 18 of 20 patients with antibiotic-resistant C. diff infections, the team reported in JAMA in October. Next, the scientists want to make pills with bacteria grown in the lab rather than extracted from feces. In the meantime, swallow quickly.

[Smoove_B]

Whoa. This is actually a pretty big deal -- Ebola remains infectious in a corpse for up to seven days:

In the study, the researchers infected five macaque monkeys—a species they believe can serve as models for humans—with Ebola, then eventually euthanized them. They placed the dead monkeys in a temperature and environment controlled chamber to simulate the climate of West Africa. Over several weeks, the researchers sampled and swabbed the tissue of their nose, mouth, blood, lung, spleen, liver and muscle.

They concluded that infectious Ebola virus remained in the macaques’ organs for three days, and in their blood for seven days, after death. Viral RNA, which wasn’t infectious, was still detectable for 10 weeks.

We knew burial practices were putting people at high risk but the idea that seven days could pass and you could still potentially transmit infection from a dead body? That's like Smallpox levels of evil.

[Isgrimnur]

Duodenoscopes

A commonly used medical scope linked to a deadly bacterial outbreak at UCLA may be so flawed it cannot be properly cleaned, federal officials conceded Thursday. But they stopped short of recalling the device or outlining any new sterilization procedures.

The U.S. Food and Drug Administration has known about the potential problems for more than two years, and took action only after The Times reported this week that two patients died in a new superbug outbreak at UCLA's Ronald Reagan Medical Center. At least five other patients have tested positive for the drug-resistant bacteria, and 179 others may have been exposed.
...
An FDA spokeswoman said that the devices' benefits outweighed the risks.

"If we pulled the devices from the market, we would prevent hundreds of thousands of patients from accessing a beneficial and life-saving procedure," said the spokeswoman, who, like other agency officials, spoke on condition she not be named. "So at this time, the continued availability of these devices is in the best interest of the public health."

The devices, called duodenoscopes, which feature a tiny camera mounted on the end of a tube that is threaded down a patient's throat and into the digestive tract, are commonly used by physicians to diagnose and treat cancer, gallstones and other conditions. Nationally, about half a million patients each year undergo the procedure, called ERCP, or endoscopic retrograde cholangiopancreatography.

Duodenoscopes are considered much less invasive and risky than surgery. And doctors credit them with saving lives through early detection and treatment.

The infections at UCLA are the latest in a series of outbreaks linked to duodenoscopes in recent years that have sickened patients at hospitals in Pennsylvania, Illinois and Seattle.

The FDA said Thursday that from January 2013 to December 2014, it received reports of 135 patients potentially infected by contaminated scopes.
...
In October, a study in the Journal of the American Medical Assn. linked bacterial infections to duodenoscopes at an Illinois hospital, even though researchers found no cleaning lapses.

The FDA acknowledged this problem in its new warning: "Some parts of the scopes may be extremely difficult to access, and effective cleaning … may not be possible."

[Isgrimnur]

Popehat tweets to the contrary, listeriosis did not kill those Kansans.

A foodborne illness linked to ice cream products may have contributed to the deaths of three hospital patients in Kansas since late 2013, but did not cause the deaths, according to health officials.

Five patients at Via Christi St. Francis hospital in Wichita developed listeriosis after eating the ice cream products from the Blue Bell creamery in Brenham,Texas, and three of them later died, the Associated Press reported.

However, listeriosis did not cause the deaths, according to Kansas Department of Health and Environment spokeswoman Sara Belfry.
...
While in the hospital, four of the five patients had milkshakes made with a Blue Bell ice cream product called "Scoops" in the month before they developed listeriosis, the CDC said.

[LawBeefaroni]

Popehat tweets to the contrary, listeriosis did not kill those Kansans.

A foodborne illness linked to ice cream products may have contributed to the deaths of three hospital patients in Kansas since late 2013, but did not cause the deaths, according to health officials.

Five patients at Via Christi St. Francis hospital in Wichita developed listeriosis after eating the ice cream products from the Blue Bell creamery in Brenham,Texas, and three of them later died, the Associated Press reported.

However, listeriosis did not cause the deaths, according to Kansas Department of Health and Environment spokeswoman Sara Belfry.
...
While in the hospital, four of the five patients had milkshakes made with a Blue Bell ice cream product called "Scoops" in the month before they developed listeriosis, the CDC said.

It was certainly a factor in the three deaths. While they can't release medical information on the deceased, they were all older and were admitted for something. They may or may not have survived without the listeria but it certainly didn't help. Fairly obviously a comorbidity.

It's like how a car accident didn't kill that guy, loss of blood and heart failure did.

[Isgrimnur]

Oh, I know. There was a certain tongue in cheek factor to my post.

comorbidity

Exactly the word I debated about whether or not to include in the post.

[Isgrimnur]

NYC rats

After 10 months of crawling under the city, the researchers caught 133 rats. On those rats, they found a total of 6,500 fleas, lice and mites: tropical rat mites, spiny rat mites, spiny rat lice, and Oriental rat fleas. That’s not good, since rat fleas (Xenopsylla cheopis) are the ones that transmit plague and murine typhus.

The researchers sampled their Oriental rat fleas for a variety of pathogenic bacteria. Good news! They did not find any plague or typhus bacteria in New York City rat fleas.

A calculation called the Flea Index is used to calculate risk to humans of plague. It’s basically the average number of fleas on a rat. If the Flea Index is below 1 (1 flea/rat), then there is minimal risk of a disease establishing itself in a population. In 1925, the calculated Flea Index for New York was 0.22. In the newly published study, the flea index was 4.1.
...
The distribution of rats and fleas in the city is also very spotty; not all rats had fleas, and not all areas sampled had rats. So, your risk of coming in contact with an infected rat varies widely by location.

The authors of this study also tested the rats for disease agents, and found they were infected with a wide array of disease causing bacteria and viruses. They found several types of Bartonella in fleas as well. These bacteria cause several diseases in humans, including trench fever.

[Isgrimnur]

Enterovirus D68

Last year, hundreds of children across the country got sick with what looked like a common cold. Nothing to worry about: body aches, runny nose, coughing and sneezing. But then, mysteriously, a handful of those kids became paralyzed—first, just in an arm or a leg, and then spreading so far that some children needed a ventilator to breathe. The CDC reports that since August 2014, at least 115 children in 34 states have developed unexplained muscle weakness or paralysis, which they’re now calling acute flaccid myelitis. Doctors have urgently been hunting down the origin of this strange illness for over half a year, and now they think they’ve finally identified the culprit: enterovirus D68.

Enterovirus D68 has been around for decades—it was first identified in California in 1962, and it’s one of many viral strains to blame for the common cold. It also belongs to the same genus as poliovirus, an infectious, nerve-damaging pathogen that can cause paralysis. But up until 2012, EV-D68 had never been associated with anything beyond respiratory illness.
...
Now a study in the Lancet Infectious Diseases confirms doctors’ suspicions, finally linking EV-D68 to the strange neurological effects.
...
For the first time, they also found EV-D68 in one child’s blood, which may be a sign that the virus can infiltrate the nervous system and cause paralysis.
...
Their results also suggest how this previously benign virus developed the ability to paralyze. The researchers sequenced EV-D68 samples from each paralysis patient and discovered that all of them belonged to the same strain: one that emerged in 2010, with five to six unique mutations. It’s those small changes that could explain why EV-D68 can paralyze, rather than just cause respiratory symptoms. “The virus has mutated in a direction that makes it more genetically similar to polio and other enteroviruses that cause neurological disease,” says Chiu.

Although EV-D68 genetics now more closely resemble poliovirus, it’s not clear that the virus directly causes muscle weakness and paralysis (as polio does). “I’m confident we have the culprit,” says Chiu, “but we don’t know how it’s involved in the disease.” If the virus does actually invade the nervous system, scientists still need to figure out how it invades. It’s possible that the virus might not directly attack the nervous system, but instead turn the body against itself. Chiu says EV-D68 could trigger an abnormal autoimmune response where the body produces antibodies that then invade the brain and spinal cord.

While this study shows a link to EV-D68, there’s still a small chance the virus doesn’t cause paralysis. “They’ve done a really good job showing an association,” says Avindra Nath, clinical director at the National Institute of Neurological Disorders and Stroke. “But all they have is an association—not causation—so this isn’t a smoking gun.”

[J.D.]

Enterovirus D68

Last year, hundreds of children across the country got sick with what looked like a common cold. Nothing to worry about: body aches, runny nose, coughing and sneezing. But then, mysteriously, a handful of those kids became paralyzed—first, just in an arm or a leg, and then spreading so far that some children needed a ventilator to breathe. The CDC reports that since August 2014, at least 115 children in 34 states have developed unexplained muscle weakness or paralysis, which they’re now calling acute flaccid myelitis. Doctors have urgently been hunting down the origin of this strange illness for over half a year, and now they think they’ve finally identified the culprit: enterovirus D68.

Enterovirus D68 has been around for decades—it was first identified in California in 1962, and it’s one of many viral strains to blame for the common cold. It also belongs to the same genus as poliovirus, an infectious, nerve-damaging pathogen that can cause paralysis. But up until 2012, EV-D68 had never been associated with anything beyond respiratory illness.
...
Now a study in the Lancet Infectious Diseases confirms doctors’ suspicions, finally linking EV-D68 to the strange neurological effects.
...
For the first time, they also found EV-D68 in one child’s blood, which may be a sign that the virus can infiltrate the nervous system and cause paralysis.
...
Their results also suggest how this previously benign virus developed the ability to paralyze. The researchers sequenced EV-D68 samples from each paralysis patient and discovered that all of them belonged to the same strain: one that emerged in 2010, with five to six unique mutations. It’s those small changes that could explain why EV-D68 can paralyze, rather than just cause respiratory symptoms. “The virus has mutated in a direction that makes it more genetically similar to polio and other enteroviruses that cause neurological disease,” says Chiu.

Although EV-D68 genetics now more closely resemble poliovirus, it’s not clear that the virus directly causes muscle weakness and paralysis (as polio does). “I’m confident we have the culprit,” says Chiu, “but we don’t know how it’s involved in the disease.” If the virus does actually invade the nervous system, scientists still need to figure out how it invades. It’s possible that the virus might not directly attack the nervous system, but instead turn the body against itself. Chiu says EV-D68 could trigger an abnormal autoimmune response where the body produces antibodies that then invade the brain and spinal cord.

While this study shows a link to EV-D68, there’s still a small chance the virus doesn’t cause paralysis. “They’ve done a really good job showing an association,” says Avindra Nath, clinical director at the National Institute of Neurological Disorders and Stroke. “But all they have is an association—not causation—so this isn’t a smoking gun.”

I'm a bit of a germaphobe and I have two young kids and everything you posted there is terrifying.

[Smoove_B]

Wise words of warning indeed. And sig worthy, I dare say.

It's actually much worse than even I realized. Ebola survivors are now being told to practice safe sex indefinitely:

Attention focused on Ms. Tugbah’s boyfriend, an Ebola survivor. Laboratory workers detected Ebola genetic material in a semen sample he provided 175 days after he developed symptoms. That was 74 days longer than ever found in a survivor before.

(emphasis added)

If that's the norm and not just some crazy fluke...good grief.