[Health] The Infectious Diseases Thread

[Daehawk]

Good lord tie her down and treat her.

[gilraen]

Unfortunately, things will probably get worse with our newly established precedents for "individual freedoms".

[Max Peck]

I fully expect that the public health officials trying to keep a TB outbreak from occurring have started receiving death threats by now.

[Isgrimnur]

Wired

A REPORT RELEASED today by the United Nations says that we’ve neglected a major component of the superbug problem: the environment. It serves as a reservoir for bacterial genes that create antimicrobial resistance, and it receives farm run-off and pharmaceutical effluent that let new resistance emerge.

“The same drivers that cause environment degradation are worsening the antimicrobial resistance problem,” Inger Andersen, executive director of the UN Environment Programme, known as UNEP, said in a statement. “The impacts of antimicrobial resistance could destroy our health and food systems.”

The 120-page policy document, “Bracing for Superbugs,” recognizes the environment as a place where antibiotic resistance both arises and wreaks havoc, causing as many as 1.27 million deaths per year.

[Smoove_B]

Everything old is new again as concerns grow over H5N1 - bird flu:

Veteran influenza epidemiologist Keiji Fukuda remembers vividly when he first became fearful that a virulent bird flu virus, H5N1, might be on the verge of triggering a devastating pandemic. The virus, seemingly out of nowhere, did something bird flu viruses were thought not to be able to do. It infected 18 people, killing six of them.

That happened in 1997, in Hong Kong.

A quarter century later, H5N1 has returned to the headlines, with an outbreak at a Spanish mink farm — reported in mid-January — triggering the latest round of fears that the virus might be inching closer to acquiring the ability to easily transmit among humans.

...

“Trying to predict what H5N1 will do in the human population absolutely requires a great deal of scientific humility,” cautioned Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

“I will never, ever, take H5N1 for granted,” he said.“I just don’t know what it’s going to do.”

...

“If we did have another pandemic right now I think it would be very difficult to get the public to do anything to try to limit or control transmission. That is to me a big setback,” he said.

Fukuda concurred. “What has become clear to me over time is that the big challenge is not the viruses. That’s not what gives me a pit in my stomach,” he said. “The real challenge is whether people, whether governments, whether policymakers have the ability to actually address the challenge in the way that needs to be done. And I don’t see so much which encourages me, to be blunt. That’s what gives me a pit in my stomach.”

[LordMortis]

Everything old is new again as concerns grow over H5N1 - bird flu:

Veteran influenza epidemiologist Keiji Fukuda remembers vividly when he first became fearful that a virulent bird flu virus, H5N1, might be on the verge of triggering a devastating pandemic. The virus, seemingly out of nowhere, did something bird flu viruses were thought not to be able to do. It infected 18 people, killing six of them.

That happened in 1997, in Hong Kong.

A quarter century later, H5N1 has returned to the headlines, with an outbreak at a Spanish mink farm — reported in mid-January — triggering the latest round of fears that the virus might be inching closer to acquiring the ability to easily transmit among humans.

...

“Trying to predict what H5N1 will do in the human population absolutely requires a great deal of scientific humility,” cautioned Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

“I will never, ever, take H5N1 for granted,” he said.“I just don’t know what it’s going to do.”

...

“If we did have another pandemic right now I think it would be very difficult to get the public to do anything to try to limit or control transmission. That is to me a big setback,” he said.

Fukuda concurred. “What has become clear to me over time is that the big challenge is not the viruses. That’s not what gives me a pit in my stomach,” he said. “The real challenge is whether people, whether governments, whether policymakers have the ability to actually address the challenge in the way that needs to be done. And I don’t see so much which encourages me, to be blunt. That’s what gives me a pit in my stomach.”

How were we not concerned when $3.50 a dozen were hard to come by? Did we collectively say, meh to their quadrupling in price while remaining in less than a year? Or did we just think it was chickens right to choose if they wanted a deadly flu?

[Smoove_B]

I'm excited to be reading about different diseases in the news, but then again, not Marburg virus:

Nine deaths have been confirmed, while 16 suspected patients are in quarantine. Health officials are also monitoring 15 asymptomatic close contacts of infected people.

No vaccine or antiviral treatment is approved to treat Marburg virus disease, which has an average death rate of around 50%, according to the WHO.

If anything good can come from this:

On Tuesday, the WHO convened an urgent meeting to evaluate several possible vaccine candidates that could be administered during the outbreak. The meeting brought together a consortium of vaccine developers, researchers and government officials — a group the WHO created in 2021 to advance a Marburg vaccine.

“Everything that we do needs to be done with alacrity," Dr. Philip Krause, the chair of the WHO Covid Vaccines Research Expert Group, said at the meeting. "Even if we’re going to do a study over many outbreaks, the more participants in that study that could be enrolled at each outbreak, the more likely we are to reach a conclusion sooner."

People can spread Marburg virus through blood, other bodily fluids or contaminated objects or surfaces. Past outbreaks, mostly in Africa, have had death rates of 24% to 88%, depending on the virus strain and the strength of efforts to control transmission.

[Isgrimnur]

Ah, a disease that didn't "exist" before 1967.

[ImLawBoy]

So this is a good time to have just started reading Station Eleven is what I'm hearing.

[Smoove_B]

Ah, a disease that didn't "exist" before 1967.

Come now, the best movies always start with a flashback to when explorers find new places and are exposed to different things.

Spoiler:

“All before us was clear and plain sailing. For some days two or three of our men had been complaining of severe headache, giddiness, and violent pains in the spine and between the shoulders. I had been anxious when at Gondokoro concerning the vessel, as many persons while on board had died of the plague, during the voyage from Khartoum. The men assured me that the most fatal symptom was violent bleeding from the nose; in such cases no one had been known to recover. One of the boatmen, who had been ailing for some days, suddenly went to the side of the vessel and hung his head over the river; his nose was bleeding!

Another of my men, Yaseen, was ill; his uncle, my vakeel, came to me with a report that "his nose was bleeding violently!’ Several other men fell ill; they lay helplessly about the deck in low muttering delirium, their eyes as yellow as orange-peel. In two or three days the vessel was so horribly offensive as to be unbearable. The plague has broken out! We floated past the river Sobat junction; the wind was fair from the south, thus fortunately we in the stern were to windward of the crew. Yaseen died; he was one who had bled at the nose. We stopped to bury him. The funeral hastily arranged, we again set sail. Mahommed died; he had bled at the nose. Another burial. Once more we set sail and hurried down the Nile. Several men were ill, but the dreaded symptom had not appeared. I had given each man a strong dose of calomel at the commencement of the disease; I could do nothing more, as my medicines were exhausted. All night we could hear the sick muttering and raving in delirium, but from years of association with disagreeables we had no fear of the infection.

One morning the boy Saat came to me with his head bound up, and complained of severe pain in the back and limbs, with all the usual symptoms of plague. In the afternoon I saw him leaning over the ship's side; his nose was bleeding violently! At night he was delirious. On the following morning he was raving, and on the vessel stopping to collect firewood he threw himself into the river to cool the burning fever that consumed him. His eyes were suffused with blood, which, blended with a yellow as deep as the yolk of egg, gave a terrible appearance to his face, that was already so drawn and changed as to be hardly recognized. Poor Saat! The faithful boy that we had adopted, and who had formed so bright an exception to the dark character of his race, was now a victim to this horrible disease. He was a fine strong lad of nearly fifteen, and he now lay helplessly on his mat, and cast wistful glances at the face of his mistress as she gave him a cup of cold water mixed with a few. An hour passed, and he slept. Karka, the fat, good-natured slave woman, quietly went to his side; gently taking him by the ankles and knees, she stretched his legs into a straight position, and laid his arms parallel with his sides. She then covered his face with a cloth, one of the few rags that we still possessed. ‘Does he sleep still?’ we asked. The tears ran down the cheeks of the savage but good-hearted Karka as she sobbed, ‘He is dead’.”

[Max Peck]

Wash Your Hands and Pray You Don’t Get Sick

In one very specific and mostly benign way, it’s starting to feel a lot like the spring of 2020: Disinfection is back.

“Bleach is my friend right now,” says Annette Cameron, a pediatrician at Yale School of Medicine, who spent the first half of this week spraying and sloshing the potent chemical all over her home. It’s one of the few tools she has to combat norovirus, the nasty gut pathogen that her 15-year-old son was recently shedding in gobs.

Right now, hordes of people in the Northern Hemisphere are in a similarly crummy situation. In recent weeks, norovirus has seeded outbreaks in several countries, including the United Kingdom, Canada, and the United States. Last week, the U.K. Health Security Agency announced that laboratory reports of the virus had risen to levels 66 percent higher than what’s typical this time of year. Especially hard-hit are Brits 65 and older, who are falling ill at rates that “haven’t been seen in over a decade.”

Americans could be heading into a rough stretch themselves, Caitlin Rivers, an infectious-disease epidemiologist at Johns Hopkins University, told me, given how closely the U.S.’s epidemiological patterns tend to follow those of the U.K. “It does seem like there’s a burst of activity right now,” says Nihal Altan-Bonnet, a norovirus researcher at the National Institutes of Health. At her own practice, Cameron has been seeing the number of vomiting and diarrhea cases among her patients steadily tick up. (Other pathogens can cause gastrointestinal symptoms as well, but norovirus is the most common cause of foodborne illness in the United States.)

To be clear, this is more a nauseating nuisance than a public-health crisis. In most people, norovirus triggers, at most, a few miserable days of GI distress that can include vomiting, diarrhea, and fevers, then resolves on its own; the keys are to stay hydrated and avoid spreading it to anyone vulnerable—little kids, older adults, the immunocompromised. The U.S. logs fewer than 1,000 annual deaths out of millions of documented cases. In other high-income countries, too, severe outcomes are very rare, though the virus is far more deadly in parts of the world with limited access to sanitation and potable water.

[Kraken]

Huh. I thought norovirus was mainly a cruise ship disease.

[Smoove_B]

The biggest disease outbreak I ever worked on was for norovirus and it was in a jail. Would not recommend.

Anywhere you have lots of people sharing space (dorm, school, cruise ships, etc...) it has the potential to go bonkers.

[FishPants]

I had norovirus when my kids were much smaller, and I wouldn't wish it on anyone - not life threatening but holy hell was I sick; barely controllable enough to make it to the bathroom in time. I also have a massive aversion to throwing up (I'd rather be awake and nauseous all night vs throwing up for 5 mins and going to sleep). Brutal, and I have to travel on Tuesday - I plan on disinfecting my plane seat arms/tray etc with a lysol wipe before I touch anything.

[Smoove_B]

Really not liking how this new movie is starting

https://twitter.com/kakape/status/1629095744018817024

Cambodia has informed @WHO of two confirmed cases of #avianinfluenza #H5N1, an 11 year old girl that died and another member of her family, @SCBriand just said in a @WHO press conference. Field investigations are going on, she said.

The concern is that there might be human-to-human spread. Avian influenza (historically) has much higher case fatality rates in humans *but* very low transmission rates between humans. If something changes (or has changed) that re-writes that equation? Trouble.

Nothing to do here but watch the news and listen to scientists that are following it closely. Happy Friday!

[Isgrimnur]

This week I learned that there are PhD Thatcher apologists:

The British press dubbed the future Prime Minister “Thatcher, Thatcher, milk snatcher” for sponsoring legislation to eliminate the free milk program for students over the age of seven.
...
In the UK at the time milk was delivered in glass bottles sealed with foil caps. Because the lustry caps invited attacks by birds, the milk on occasion was linked to outbreaks of bacterial poisoning caused by Campylobacter jejuni. The problem was that some birds, such as magpies and jackdaws are known to frequent rubbish and cow manure piles where such bacteria are prevalent.
...
So Margaret Thatcher, who at the time was accused of undermining the health of children, may actually have prevented some bouts of serious bacterial infection. Some Thatcher opponents now claim that the aging politician’s bent appearance is a result of calcium deficiency and is just deserved for her crimes against children. Insensitive nonsense.

[Smoove_B]

Welcome back to the list, measles:

Health officials say thousands of attendees of a religious revival at a Kentucky university might have been exposed to measles.

The Centers for Disease Control and Prevention and Kentucky Health officials said an unvaccinated and contagious person was in attendance Feb. 17 and 18. The CDC estimates that 20,000 people were in attendance at the Asbury University revival in Wilmore, Kentucky.

Officials are recommending that anyone 12 months or older who is unvaccinated against measles get the vaccination.

[Max Peck]

This week I learned that there are PhD Thatcher apologists:

In the UK at the time milk was delivered in glass bottles sealed with foil caps. Because the lustry caps invited attacks by birds, the milk on occasion was linked to outbreaks of bacterial poisoning caused by Campylobacter jejuni. The problem was that some birds, such as magpies and jackdaws are known to frequent rubbish and cow manure piles where such bacteria are prevalent.
...
So Margaret Thatcher, who at the time was accused of undermining the health of children, may actually have prevented some bouts of serious bacterial infection.

In our next hot take, famine is actually good because you can't have foodborne disease if there's no food.

[Isgrimnur]

[Smoove_B]

Be safe out there folks:

The U.S. could see a renewed surge of mpox infections even worse than last year, new federal modeling has concluded, based on data showing most American communities remain far short of vaccination rates needed to fend off outbreaks in at-risk groups.

With "moderate confidence," the CDC's modelers said in a report published Thursday that most parts of the country have a "greater than 35%" risk of mpox, formerly known as monkeypox, resurging over the coming months.

"It's not us saying get more people vaccinated because we think it's a good idea. We need to get more people vaccinated because we know there's a linear relationship between how many people are vaccinated and the chance of not having an outbreak," Dr. Demetre Daskalakis, deputy coordinator for the White House's mpox response, told CBS News on Thursday.

Of note:

The CDC estimates that just 23% of the "at-risk population" for mpox, like men who have sex with men and people with multiple sex partners, have been fully vaccinated. Vaccination rates are in the single digits across many states.

Authorities are now ramping up outreach ahead of the return of travel, and events in the warmer months could fuel the renewed spread of the virus, alongside other sexually transmitted infections.

[Jeff V]

The biggest disease outbreak I ever worked on was for norovirus and it was in a jail. Would not recommend.

Anywhere you have lots of people sharing space (dorm, school, cruise ships, etc...) it has the potential to go bonkers.

Lovely. We're now booked on a cruise in December, I guess I have this to look forward to. Last time I was in the state, Florida gave me Covid.

[Smoove_B]

Despite what you might have heard, they can dust for vomit.

This is *the* gold standard story for norovirus spread. Being able to trace it back to attendees being exposed to vomit plumes is the kind of science I can only dream of experiencing. In my case, it was spread by a kitchen worker making drink mix for everyone - he contaminated the supply with his saliva while tasting to see if it was being prepared correctly.

Anyway, perhaps consider some masks in your luggage in case you need to dodge aeresolized vomit while at sea.

[Isgrimnur]

Mpox, ba duba dox
Ba du pox, ba duba dox
Ba du pox, ba duba dox
Ba du, oh yeah

[Smoove_B]

If I was crafty I'd create a TikTok to promote awareness using that theme, but I'm just not there.

[Kraken]

Covid is bad news for the demented.

Infection with SARS-CoV-2 has a significant impact on cognitive function in patients with preexisting dementia, according to new research, published in the Journal of Alzheimer’s Disease Reports.

Patients with all subtypes of dementia included in the study experienced rapidly progressive dementia following infection with SARS-CoV-2.

[Victoria Raverna]

Seem like almost every week there are news about fungus infection. Is that a new threat or just something that blow up because of The Last of Us?

[Sudy]

Covid is bad news for the demented.

Infection with SARS-CoV-2 has a significant impact on cognitive function in patients with preexisting dementia, according to new research, published in the Journal of Alzheimer’s Disease Reports.

Patients with all subtypes of dementia included in the study experienced rapidly progressive dementia following infection with SARS-CoV-2.

Obviously anecdotal, but my 95-year-old grandmother took a sharp decline after her first bout of COVID, living with my parents. While she'd been in decline in the preceding months and years, she steeply declined and had to be placed in the dementia wing of an assisted living facility afterward. (I think she's also been re-infected there once or twice. It's a pretty good facility but I've questioned their methods. I know outbreaks must be hard to avoid even when proper procedure is followed though. But I don't feel great about her being locked in her room during outbreaks. That's definitely not good for her mind. The facility actually just eliminated COVID testing upon entry for visitors this past month.

It's entirely possible this was coincidental, but it's hard not to connect the two. At least she knew where she was living and recognized me beforehand. Now she doesn't know the former and it's even money whether she knows who I am. She can't remember whether her parents are alive, or my grandfather who passed thirty years ago next year. Dementia is just horrific and heartbreaking. I'm also terrified for both my parents and myself, as three of my four grandparents suffered from it. Mind you, the one passed at 70 but the others made it to 90 and 95, and the latter's still going. But the preceding decade wasn't any way to live.

[Max Peck]

When this is made into a movie, I wonder if she'll be the hero or the villain?

Woman with untreated TB is on the lam, took city bus to casino

A Tacoma, Washington, woman who has refused court-ordered tuberculosis treatment for over a year is evading arrest and has reportedly taken public transit to go to a casino while on the lam.

The Tacoma-Pierce County Health Department has been trying to get the woman to comply with treatment since at least January 2022, when she received her first court order. Since then, she has received over a dozen court orders for treatment and isolation amid monthly court hearings and order renewals. Last month, Pierce County Superior Court Judge Philip Sorensen finally found her in contempt and issued a warrant for her arrest and involuntary detention at the county jail for treatment and isolation.

"In each case like this, we are constantly balancing risk to the public and the civil liberties of the patient," the health department wrote in a blog post days before the arrest warrant was issued. "We are always hopeful a patient will choose to comply voluntarily. Seeking to enforce a court order through a civil arrest warrant is always our last resort."

But, according to a report from The News Tribune, the woman continues to buck authorities, evading apprehension and her court-appointed monitor.

[stessier]

For Smoove
Trendy “raw water” source under bird’s nest sparks diarrheal outbreak

Nineteen people fell ill with a diarrheal disease in Montana last year after drinking untreated water that many believed to be from a natural spring but which was, in fact, just creek drainage brimming with pathogenic bacteria.

One person was hospitalized in the outbreak, which ended only after authorities diverted the water source, local health officials reported Thursday in Morbidity and Mortality Weekly.
The outbreak follows a trend that sprang up in the US several years ago of drinking so-called "raw water." That is untreated, unfiltered water collected directly from freshwater sources that is often claimed—without evidence—to have health benefits.

Proponents have argued that raw water avoids undesirable components of municipal water, which they identify as disinfectants, fluoride, imaginary "mind-control" drugs, traces of pharmaceuticals, and heavy metals, such as lead from pipes. They also suggest, without evidence, that raw water can contain unique probiotics and other "natural" minerals and compounds that can improve health.

Health officials have pointed out that untreated, unfiltered water is a clear health risk, given the likelihood of pathogenic bacteria, viruses, and parasites, as well as naturally occurring contaminants, such as radionuclides and mineral deposits.

[Blackhawk]

Something something Darwin.

[Hrothgar]

Great, now I have the image in my head of Smoove kicking back in his plastic bubble reading Morbidity and Mortality Weekly.

[Isgrimnur]

Morbidity and Mortality Weekly

[Smoove_B]

So happy (as weird as that sounds) to have another story to use that doesn't involve Beaver Fever. That's a great write up and a perfect example of how an investigation should go. We have some legitimate local springs in my part of the state (in a park) that people drive from all over to fill up jugs for home use. I can totally see how this happened based on how it was described.

Great, now I have the image in my head of Smoove kicking back in his plastic bubble reading Morbidity and Mortality Weekly.

Thank god the bubble doesn't interfere with the wifi.

[Blackhawk]

Beaver Fever

I can't help but imagine that this was an 80s summer camp movie.

[Smoove_B]

I still need to suppress a giggle when I talk about it, because I'm mentally 15.

[Isgrimnur]

[Isgrimnur]

BBC

The US Food and Drug Administration has approved a vaccine against respiratory syncytial virus (RSV) - an illness that kills thousands of Americans each year.

The vaccine still needs approval from the US Centers for Disease Control and Prevention before it can be rolled out to the public.

Officials say the vaccine, named Arexvy by the manufacturer GSK, is a major breakthrough that will save many lives.

It could be available to people over 60 within months, officials say.
...
On average, it kills 100-300 children under the age of 5 in the US every year, according to the CDC.

It also kills about 6,000 to 10,000 adults over 65 annually, and causes between 60,000 to 120,000 hospital admissions.

[Kraken]

Sign me up. I probably had RSV in February, when I tested negative for covid and flu but was as sick as I can ever remember being. Would prefer not to do that again.

[Max Peck]

From the files of Beth Mole, a Florida Man story...

Florida man gets flesh-eating infection from human bite during family fight

A Florida man nearly lost his leg from a rare flesh-eating bacterial infection that developed after he was bitten by a human while breaking up a family brawl, according to a report by NBC News.

The man, Donnie Adams, a 53-year-old funeral assistant from the Tampa suburb of Riverview, sought care in mid-February for a painful swelling on this bitten thigh. He told doctors he had gotten the bite while trying to break up a physical fight between two family members. He was bitten in the process of pulling the pair away from each other.

He reportedly declined to say what sparked the brawl or which family member actually bit him. But doctors believed his story after seeing the wound.

"When I saw him in the hospital, you could still see the bite marks on his thigh," Dr. Fritz Brink, a wound care specialist at HCA Florida Healthcare who treated Adams, told NBC News. "It made teeth marks. I was very convinced that he was telling a true story."

[Punisher]

From the files of Beth Mole, a Florida Man story...

Florida man gets flesh-eating infection from human bite during family fight

A Florida man nearly lost his leg from a rare flesh-eating bacterial infection that developed after he was bitten by a human while breaking up a family brawl, according to a report by NBC News.

The man, Donnie Adams, a 53-year-old funeral assistant from the Tampa suburb of Riverview, sought care in mid-February for a painful swelling on this bitten thigh. He told doctors he had gotten the bite while trying to break up a physical fight between two family members. He was bitten in the process of pulling the pair away from each other.

He reportedly declined to say what sparked the brawl or which family member actually bit him. But doctors believed his story after seeing the wound.

"When I saw him in the hospital, you could still see the bite marks on his thigh," Dr. Fritz Brink, a wound care specialist at HCA Florida Healthcare who treated Adams, told NBC News. "It made teeth marks. I was very convinced that he was telling a true story."

Wouldn't that mean that the person that bit him already had the infection and wouldn't they have shown symptoms?