[Health] The Infectious Diseases Thread

[LordMortis]

Most people don't realize that the DTaP childhood vaccine wears off.

Probably because up until ~20 years ago, those vaccinations were at ~93%+ nationwide so your risk of actually being exposed to Whooping Cough was pretty low as an adult. But now that vaccinations aren't cool and childhood vaccine-preventable diseases are in regular circulation again, adults are also at risk.

I still cannot believe I actually thought the vaccine issue was going to be put to rest in my lifetime. It's way worse now than when I started in the field and I still can't process it.

And I keep getting all the sicks. Aside from COVID which I seek out, I rely on my PCP to keep me up to date, but now I feel like I have to try and stay informed and ask "Should I do x?" I hate that because I am not medically knowledgeable and I have to get medically knowledgeable so I can ask a doctor, then what do I need the doctor for anyway? If it's to keep me from making a miss step, a pharmacist can do that.

[Smoove_B]

You can always check here, specifically this tool if you don't want to rely on your doctor.

EDIT: Removed R&P, sorry

[Kraken]

Smoove, you might consider moving to Rwanda. “Unprecedented” good news story about a Marburg outbreak.

Marburg virus is notorious for its killing ability. In past outbreaks, as many as 9 out of 10 patients have died from the disease. And there are no approved vaccines or medications.

That was the grim situation in Rwanda just over a month ago, when officials made the announcement that nobody wants to make: The country was in the midst of its first Marburg outbreak.

Now those same Rwandan officials have better news to share. Remarkably better.

“We are at a case fatality rate of 22.7% — probably among the lowest ever recorded [for a Marburg outbreak],” said Dr. Yvan Butera, the Rwandan Minister of State for Health at a press conference hosted by Africa Centers for Disease Control and Prevention on Thursday.

They did it with robust public health services.

Incidentally, if Covid-19 had debuted with a 90% fatality rate you and yours would have found more love here.

[Blackhawk]

We could learn from Rwanda.

We've become the Third World of healthcare.

[Smoove_B]

I've been following the various Marburg outbreak stories these last few years, but I missed this - the news cycle is full.

Thanks for posting it. Amazing what we can do when there's motivation.

[AWS260]

Cholera and other diarrheal diseases suck, but they sucks a lot less than they used to thanks to Richard Marlink. R.I.P.

Dr. Cash and Dr. Nalin conceived a trial in which they carefully measured the amount of liquid lost and replaced it with the same amount, mixed with salt and sugar to facilitate absorption.
***
The World Health Organization estimates that oral hydration therapy has saved more than 50 million lives, a majority of them children. In 1978, the British medical journal The Lancet called their innovation “potentially the most important medical advance this century.”

It doesn't say in the story, but one common way to measure how much liquid is lost is by putting the patient in a plastic-covered bed with a hole in the middle, and putting a bucket under the hole. Weigh what's in the bucket, and that's how much fluid they need. Science!

[Max Peck]

Cholera and other diarrheal diseases suck, but they sucks a lot less than they used to thanks to Richard Cash. R.I.P.

FTFY

[AWS260]

Whoops, thanks. I originally saw the obit when it was posted by Richard Marlink, another global public health notable.

[Smoove_B]

And we're off:

Almost from the beginning of the spread of H5N1 bird flu among farms and ranches in the U.S. earlier this year, experts and researchers warned that a critical lag in the blood testing of exposed workers might lead to an underestimation of the virus’s potential transmission to humans.

Those warnings have proved prophetic. And the federal Centers for Disease Prevention and Control (CDC) now finds itself not only trying to blunt the spread of the virus, but also playing catch-up with testing methods that have been largely resisted among America’s farmers.

The question now is whether new interventions can ward off mass human-to-human transmission of this strain—because to some experts, it’s only a matter of time.

More:

“This generally confirms what we knew: There are more people that are getting infected on farms than the official tally. The serology bears that out,” says Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security. “That’s the reason why so many of us have been wanting more aggressive serological testing on farms, in order to understand the extent of infection and better understand the risks that the virus poses (there).”

During a press briefing on Thursday, CDC principal deputy director Nirav Shah said that nothing in the new data “gives rise to a concern about person-to-person transmission,” adding that the agency believes the virus still poses only a low risk to the general public.

What's happening:

“I don’t think it’s a foregone conclusion that H5N1 is going to be the cause of the next pandemic, but certainly an avian influenza virus in the future will be,” says Adalja. “And I think we have to get it right with this one. Even if it can’t cause a pandemic, we want to think of this as a trial run—and we’re not doing things that are really great, from a trial run perspective, with this virus.”

The CDC recommended Thursday that farm workers with a significant bird flu exposure be tested for H5N1 whether or not they experience symptoms, a measure that could be important as the traditional flu season begins and sorting out one virus from another becomes more challenging. “The best way to limit the virus’s room to run is to test, identify, treat and isolate as many cases as possible in humans and as quickly as possible,” said Shah.

In closing:

Now, those health officials and the agencies they direct are scrambling to find ways to safeguard both people and livestock against a virus that has already infected 446 dairy herds in 15 states and more than 100 million birds, mostly commercial poultry, in addition to the documented human cases. Bird flu’s reported 52% mortality rate in Europe since 2002 is a grim reminder of the stakes—and only massively enhanced prevention, testing and treatment efforts will do, along with complete public transparency about the results of those efforts.

Adalja and some other experts do not believe that this subtype of H5N1 circulating in dairy cows in the U.S. is as severe in humans as other clades have been. But, “what is concerning is the fact that this has been something that’s been allowed to get this way,” Adalja says. “This is something that many of us in the field have been talking about being more aggressive about for months.”

The clock is ticking louder.

I'll be watching...

[Blackhawk]

Luckily, we're going to be going into the next few years with robust public health infrastructure.

[Smoove_B]

Indeed. Hold on to your butts.

[Max Peck]

My understanding is that ivermectin and bleach enemas are just as effective for H5N1 as they are for COVID-19, so I'm confident that everything will be fine.

[Kraken]

To be fair, any government would try to dodge taking action in this day and age. Pandemics are wicked unpopular, and those who insist that we address them are not liked.

[Smoove_B]

and those who insist that we address them are not liked

I am aware, yes.

[TheMix]

Except around here.

[Smoove_B]

Probably the only thing from keeping The Dark Passenger from taking over, thanks.

[Smoove_B]

My understanding is that ivermectin and bleach enemas are just as effective for H5N1 as they are for COVID-19, so I'm confident that everything will be fine.

Might be time to stock up:

British Columbia health officials are investigating what's believed to be the first human case of avian influenza caught in Canada after a teenager tested presumptively positive for the disease, the Ministry of Health announced Saturday.

The teenager, who the ministry says is from the Fraser Health region, is currently receiving care at B.C. Children's Hospital, while officials work to confirm the diagnosis and trace potential sources of exposure.

According to the statement, avian influenza, also known as bird flu, is a virus that primarily affects birds but can occasionally spread to humans through contact with infected animals or contaminated environments.

B.C.'s provincial health officer, Dr. Bonnie Henry, says the case marks the first time H5 avian influenza has been caught by a person in Canada, as far as they know, although there have been isolated cases reported in the U.S. and other countries.

This would suggest (to me) that H5 is spread much, much wider than we realize - and we're just not testing/monitoring for it.

[Smoove_B]

Update to story in previous post:

British Columbia’s provincial health officer Dr. Bonnie Henry says the teenager who has tested positive for bird flu is in critical condition and being treated at B.C. Children’s Hospital.

Henry says the teen, who has the first presumptive human case of bird flu contracted in Canada, was admitted to hospital late Friday.

She says it’s likely that the teenager contracted the illness from exposure to an animal or the environment, although there’s a “very real possibility” that the source will never be found.

Henry says 12 other people have been tested for avian flu, including medical workers who came into contact with the teen, but they haven’t identified anyone else as having the illness.

She says they have found no link between the teen and any of the two dozen poultry farms in B.C. that have suffered avian flu outbreaks during the fall migration of wild birds.

[Blackhawk]

I will be making the tough call to not bring any rescued birds I'm pointed to into the house, and to double down on the protections if I do handle them.

[Smoove_B]

Probably a good idea as the latest news indicates the teenager that has it in Canada - the genetic testing suggests it came from a wild bird, not a cow.

[Kraken]

Severe Covid might shrink cancer tumors

Immune cells produced during a severe COVID-19 infection may cause cancerous tumors to shrink, research in mice suggests.

The study, published Friday (Nov. 15) in The Journal of Clinical Investigation, found that genetic information from the virus that causes COVID-19 led the immune system to produce special cells with anti-cancer properties. These immune cells, a type of white blood cell called monocytes, helped shrink several types of cancer in mice.

Normally, cancer spreads when monocytes assemble at a tumor site. The tumor cells then convert these monocytes into cancer-friendly cells, said study lead author Dr. Ankit Bharat, chief of thoracic surgery at Northwestern Medicine. These monocytes then help shield the cancer cells from the immune system, allowing tumors to grow.

"They essentially form like a castle around the cancer cells, protecting them from being invaded by the body's immune system," Bharat told Live Science.

Past research has shown that certain inflammatory conditions, such as COVID-19, can induce changes in monocyte properties. These "induced" monocytes are trained to specifically target the virus to orchestrate a more effective immune response, said Dr. Christopher Ohl, an infectious-disease specialist at Atrium Health Wake Forest Baptist and a professor at Wake Forest University School of Medicine in Winston-Salem, North Carolina, who was not involved in the study.

Bharat and his colleagues had noticed that some patients who had both severe COVID-19 and cancer had their tumors shrink after infection.

It's a bit premature for cancer patient to hold Covid parties, but the mechanism could lead to improved immunotherapies if it holds up to further study.

[Punisher]

Democrats fighting to keep cancer. Find out how their vaccines ruined a chance for cancer pts to be cancer free.
News at 6 only on Fox.

[Max Peck]

Intuitively, it seems like a vaccine could be designed to replicate the behavior without needing to run the COVID gauntlet.

[Smoove_B]

As if we have the luxury of researching anything COVID-19 related that's positive. I have been looking for a write up to share, but this is the best I can find, in terms of explaining it easily:

Ok, this is actually concerning. The sequence of the hospitalized teen with H5N1 has been released. Both of these mutation sites are known to impact α2,6 binding that is needed for human to human transmissibility.

Need top experts on H5N1 to immediately to look into this.

...

It is also concerning that this is the first severe case we've had in North America out of many now. Is it a coincidence that these potentially h-h supporting mutations are linked to the most severe outcome?

...

The right mutations at these sites can, on paper, significantly increase h-h transmission. That's why there needs to be immediate focus on this sample. Somewhat unclear if the mutations occurred in this patient or prior to their infection.

So in short, we have a teenager (presumably part of one of the healthiest cohorts we have) with no prior identified health conditions that is in critical condition following an H5N1 infection. Worse, they've identified that the variant this teenager is infected with has two mutations that increase it's ability to spread from person to person.

I'm not saying this is the end by any means, but this is looking like we're once again at the precipice of another pandemic, just sorta gazing out into the abyss.

[Isgrimnur]

United States’ first known case of more severe strain of mpox confirmed in California

The risk of clade I mpox to the public remains low, the agency said.

The person diagnosed with clade I mpox had recently traveled from Eastern Africa, where an mpox outbreak is ongoing. The person was treated at a local medical facility and released, the CDC said. The person has been isolating at home and their symptoms are improving. The state and CDC are working to identify and follow up with potential contacts.

Clade II mpox has been circulating in the United States since a large outbreak in 2022 and 2023. A more recent outbreak in Africa is driven by clade I, which is known to cause more severe disease.

[Isgrimnur]

E. coli outbreak linked to organic carrots sickens people in 18 states

One person has died and at least 38 people have become ill following an E. coli outbreak linked to organic carrots, according to federal health officials.

The Centers for Disease Control and Prevention said Sunday that cases emerged between Sept. 6 and Oct. 28 across 18 states, with Washington, Minnesota and New York reporting the highest number of cases.

The CDC warned that the outbreak may have reached additional states and the actual number of infected individuals is likely much higher than reported.

[Smoove_B]

First article I'm seeing about the news I posted last week:

The teenager hospitalized with bird flu in British Columbia, Canada, may have a variation of the virus that has a mutation making it more transmissible among people, early data shows – a warning of what the virus can do that is especially worrisome in countries such as the US where some H5N1 cases are not being detected.

The US “absolutely” is not testing and monitoring bird flu cases enough, which means scientists could miss mutated cases like these, said Richard Webby, a virologist at St Jude children’s research hospital’s department of infectious diseases.

Thankfully we have nothing going on right now and I'm sure this is totally a priority.

I did see reports that there's a case in Alameda County area of CA right now being investigated that is suspected as being bird-to-human transmitted. It's not in the news yet, just dashboard data so hopefully we get more info soon.

In short, buckle up.

“If we have human cases that are undetected, that increases the risk that some of these viruses could be passed on, and by the time we do detect them it might have spread further,” Rasmussen said. “That’s why we do need to remain very vigilant about this.”

The possibility of a more-transmissible virus was a warning sign, Webby said. It “stresses the need that we’ve got to do something about this virus. We’ve got to get it under control.”

[Dogstar]

Are there any signs for optimism that the multitude of H5N1 strains that are probably out there are potentially less lethal than the current CFR, or is just the overwhelming fear that it continues to mutate and becomes more communicable too without a significant drop in the mortality rate the prevalent feeling in the medical/infectious disease community?

[Smoove_B]

Any optimism is tempered with the knowledge that uncontrolled spread is occurring - which increases the chances the right combination will eventually result in (1) highly transmissible and (2) highly virulent for humans.

Making it worse is that we have two separate things happening. First, it's seemingly spreading in the agricultural industry and then second (likely connected to the first) is evidence suggests it's moving through wild bird populations. Many have noted that if what is happening in our agricultural industry was happening anywhere else on the planet, the United States would be speaking out and calling for action - as some nations have observed and implied already we should be getting a handle on what's going on. PA just announced earlier this week that they're going to start batch testing milk (which is good) but the effort to protect and monitor workers is not going well, nationwide.

So yeah, lots of people pointing out this is a recipe for disaster but there's an unwillingness to take a proactive, aggressive response and it's been that way for months. Of course, given the last 5 years this shouldn't be a surprise and yet, here we are again seemingly rolling the (genetic) dice.

[Blackhawk]

When I was a kid, I believed that America was the shining beacon that the world wanted to be like.

As an adult, I may live to see America's greed and pettiness being responsible for crushing humanity in a way that we haven't experienced in 700 years.

[Smoove_B]

Indeed. What's happening is right now (with respect to zoonotic illnesses) was inevitable; it's been pondered for decades (to various degrees) by academics, researchers and people in government.

I'm not going to lie, I do kinda wish it wasn't happening right now. Again. To quote that wizard:

“I wish it need not have happened in my time," said Frodo.

"So do I," said Gandalf, "and so do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given us.”

[Blackhawk]

Then I shall return to my hobbit-hole, put my feet up, sip a cup of tea, and smoke a pipe of Longbottom leaf while I wait for the end of all things. For what can the little folk do, in the face of such a rising darkness?

[Smoove_B]

Get every vaccination you and your family qualify for ASAP, purchase/acquire the best masks you can get your hands on and yeah...hope for the best.

[Max Peck]

I'm all vaxxed up and have a sizable stockpile of N95/FFP3 trifold respirators, but I see that Amazon has some really good deals on canned tuna right now.

Can't hurt to stock up on some shelf-stable protein, right?

[Smoove_B]

Always a good idea regardless. Anything you can do to minimize the need to leave your house (i.e. you need to shelter in place) is reasonable.

[LawBeefaroni]

Quarantine/shelter in place isn't going to happen until there are bodies in the street. No one has the balls to declare one or the willingness to obey one.

[Smoove_B]

I guess I wasn't only referring to the need to shelter in place for infectious disease outbreaks. Anything at all that allow you to stay at home while others are racing around to get food and water is a smart plan. Storms. Power outages. Civil Unrest. Airborne Ebola. Robots. Anything helps.

Also, if the "bird flu" hits like we fear, it will unravel the fabric of society, so no worries about waiting on people to "make the call" on things. It will be disruptive in ways the modern world hasn't seen.

[Holman]

Also, if the "bird flu" hits like we fear, it will unravel the fabric of society, so no worries about waiting on people to "make the call" on things. It will be disruptive in ways the modern world hasn't seen.

At least not since 1918.

[Zarathud]

If anyone is going to take the blame for bird flu, it should be Trump. That would make him responsible for screwing up two major pandemics. We’re in the worst timeline, so it is of course inevitable.

But it may also be the quickest way to prove to the unintelligent the need for effective, fact-based government. And that Republicans deliver only chaos and failure.

[Punisher]

Quarantine/shelter in place isn't going to happen until there are bodies in the street. No one has the balls to declare one or the willingness to obey one.

Maybe not officially but some of us may choose to do so voluntarily before fits hit the shan.
I know that I have enough medical issues as it is.