Category Archives: Epidemiology

Jenny McCarthy: “Playmate,” Co-Host on “The View,” & “Medical Expert”. Well, 2 Out of 3 Ain’t Bad.

Jenny McCarthy, Head and Shoulder

Jenny McCarthy, courtesy Playboy Enterprises

Jenny McCarthy, pictured above, is not a medical expert. After she became convinced that her son’s autism was triggered by vaccines, the actress, model, and “Playmate” associated herself with Generation Rescue, which promotes the unfounded anti-scientific belief that autism is caused by vaccines.  McCarthy has appeared on Larry King Live, in 2008, Youtube here, Oprah and currently co-hosts “The View,” a talk show on daytime television on the ABC network. ABC’s decision to hire her in this role was criticized in NJ.com, PLOS, the LA Times.

The problem is one needs nothing more than notoriety to become a pundit, and “pundits” who speak convincingly while they utter nonsense can cause real harm.

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DebateGraph.org: visualization and collaboration tools

Debategraph is a software tool with applications for addressing, defining and attacking many types of problems in many ways. Here’s one of their interactive maps on epidemiology:

Who’s using it? Apparently the White House, CNN, the Prime Minister and the Foreign Office in the United Kingdom. A concept map explaining DebateGraph itself appears below.

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Gonorrhea Evolving; Almost Untreatable

Treatment history. Courtesy of CDC and the AthlanticJames Hamblin, MD, at The Atlantic, here,  writes,

The list of effective antibiotics has been dwindling as the bacteria became resistant, and now it’s down to one. Five years ago, the CDC said fluoroquinolones were no longer effective, but oral cephalosporins were still a common/easy treatment. Now injected ceftriaxone is the only recommended effective drug we have left. And it has to be given along with either azithromycin or doxycycline.

Dr. Hamblin and The Atlantic also reproduced the graphic, above, tracing the treatments in use from 1988 to 2010.  Penicillins stopped being effective in the early 1990’s. While this news is disturbing, it also illustrates how evolution works. A small percentage survive because of natural resistance. They reproduce. Their offspring have the resistant genes.  Whether it’s grey moths that are obvious on trees in pristine environments and difficult to see on trees where the smog coloured the bark, pests in a farm field, or infectious bacteria, the principle is the same.

Looking from a whole systems perspective, maybe we need to develop medications that stimulate the human immune response, rather than medications that try to kill the bacteria. Continue reading →

Researchers posit new disease vector: trans-oceanic airbone pathogens: NPR

Kawasaki disease affects about 4,000 children a year in the United States, but many more in Asia. As a consequence, even the best American pediatricians may have difficulty making the correct diagnosis, particularly on first impression. Now researchers have correlated wind patterns to and from Japan and the U.S. West Coast with the timing of Kawasaki outbreaks in both locations.

A Windborne Clue To A Mysterious Childhood Disease: on NPR.org – a direct link to the audio is on the page.

 

Cleaning Up In Hospitals

Germs on the hand

Germs on the Hand. Courtesy Talk is Cheap

5% of hospital patients develop an infection. And the majority of those infections are acquired from the hands of Health Care Providers.

Medicare pays 40% of the nation’s hospital bills. (This, in and of itself, is an argument for a single payer system – one single payer already pays 40% of hospital bills. And it’s the Government.) However, Medicare does not reimburse hospitals for their mistakes. It shouldn’t. If I borrow your car, and run out of gas, it’s my fault, not yours. Note that this is an example of the government doing something right.

Because of this policy decision, medical accidents went from being a source of hospital revenue to a massive financial drain. Medical institutions were forced into the business of disease prevention, at least once people were in their care.

According to the Committee to Reduce Infection Deaths statistics, (PDF) hospital acquired infections kill more people in America than AIDS, Breast Cancer and Auto Accidents combined. What is worse is that 5% of the patients in hospitals acquire infections in the hospital, and the vast majority of the patients that acquire such infections in hospitals get them from the hands of health care providers.

More details after the click.

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Biological warfare – not for Amateurs. Or is it?

From Carl Zimmer, writing on NYTimes.com, an excerpt from Amateurs Are New Fear in Creating Mutant Virus:

Just how easy is it to make a deadly virus?

This disturbing question has been on the minds of many scientists recently, thanks to a pair of controversial experiments in which the H5N1 bird flu virus was transformed into mutant forms that spread among mammals. After months of intense worldwide debate, a panel of scientists brought together by the World Health Organization recommended last week in favor of publishing the results. There is no word on exactly when those papers — withheld since last fall by the journals Nature and Science — will appear. But when they do, will it be possible for others to recreate the mutant virus? And if so, who might they be and how would they do it?

Not quite the DIY spirit we generally try to encourage. And we don’t have a ready policy answer. Comments solicited. Further  resources:

NIH: Avian influenza (H5N1)

Scientists Debate How to Handle Mutant H5N1 Virus

 

PFCs, chemicals widespread in children, appears to impair children's immune systems

This is Jon Hamilton‘s excellent explanation of this disturbing risk possibility, reported yesterday in JAMA. From Common Chemicals Could Make Kids’ Vaccines Less Effective

The more exposure children have to chemicals called perfluorinated compounds, the less likely they are to have a good immune response to vaccinations, a study just published in JAMA, the Journal of the American Medical Association shows.

The finding suggests, but doesn’t prove, that these chemicals can affect the immune system enough to make some children more vulnerable to infectious diseases.

For decades now, PFCs have been used in nonstick coatings, stain-resistant fabrics and some food packaging. And because they persist in the environment for years, they have become common around the globe.

“You can find them in polar bears,” says Dr. Philippe Grandjean, the study’s lead author who works at both Harvard and the University of Southern Denmark.

Studies in animals have shown that PFCs can weaken the immune system.

Grandjean wanted to know whether this was happening in children. So he led a team that studied nearly 600 kids in the Faroe Islands, which lie about halfway between Scotland and Iceland.

The Faroese have levels of PFCs similar to those of U.S. residents. Grandjean figured if the chemicals were having an effect, it would show up in the way kids’ bodies responded to vaccinations.

Normally, a vaccine causes the production of lots of antibodies to a specific germ. But Grandjean says the response to tetanus and diphtheria vaccines was much weaker in 5-year-olds whose blood contained relatively high levels of PFCs.

“We found that the higher the exposure, the less capable the kids were in terms of responding appropriately to the vaccine,” Grandjean says. The results raise the possibility that “the immune system is not really developing optimally.”

The health effects of PFCs are still poorly understood. But in the past decade, government scientists have become increasingly concerned about possible links to developmental problems in children.

If this turns out to be coincidental, without causal connection, all well and good. But if there’s something here that, on the precautionary principle, would lead us to ban or limit PFCs – it’s likely we’ll do it first in more affluent countries. This may protect some children – but if the children of entire continents are left unprotected, not only are those children at direct risk, their communities may constitute international disease paths. In a world with routine international travel and shipping, diseases don’t need green cards.

Guardian: Guangdong bus driver killed by H5N1 flu strain

A Chinese man diagnosed with the country’s first case of bird flu in more than a year has died in the southern city of Shenzhen.

The 39-year-old bus driver was admitted to hospital with pneumonia but tested positive for the H5N1 bird flu virus. This is the third case in two weeks. This report is disturbing on its face. That said, we wonder how many people around the world would be willing to bet their lives on the Chinese government’s veracity. Please feel free to comment, but let’s try to keep it polite. Excerpted from
Bird flu virus kills Chinese man

A Chinese man diagnosed with the country’s first case of bird flu in more than a year has died in the southern city of Shenzhen.

The 39-year-old bus driver was admitted to hospital with pneumonia but tested positive for the H5N1 bird flu virus.

The strain has a high mortality rate, killing up to 60% of infected humans.

The man, surnamed Chen, developed a fever on 21 December and was admitted to hospital on Christmas Day. Local health officials said 120 people who had close contact with Chen have not developed any abnormal symptoms.

The Chinese health ministry has informed the World Health Organisation about the case, health officials added.

During the month prior to his fever, Chen, apparently had no direct contact with poultry and did not travel out of Shenzhen.

The city, home to 10 million people, is separated by a small river from Hong Kong, where 19,000 chickens have been slaughtered after two were confirmed last week to have died from the H5N1 virus.

With thanks to The Guardian and staff for their coverage.

The city, home to 10 million people, is separated by a small river from Hong Kong, where 19,000 chickens have been slaughtered after two were confirmed last week to have died from the H5N1 virus.

Measles outbreak in Europe

Via the BBC, alarming news. The World Health Organization warns of measles outbreak in Europe, which has included 26,000 cases and nine deaths.
From WHO issues Europe measles warning:

European countries need to act now to tackle measles outbreaks, the World Health Organization warns. The WHO report says there were over 26,000 measles cases in 36 European countries from January to October 2011. Western European countries reported 83% of those cases, with 14,000 in France alone. In England and Wales, there were just under 1,000 confirmed measles cases in that period – compared with just 374 in the whole of 2010. Altogether, measles outbreaks in Europe have caused nine deaths, including six in France, and 7,288 hospitalisations. France has now launched a nationwide campaign to raise awareness about the need for MMR vaccination. Jean-Yves Grall, the Director-General for Health in France, said: “France can simply not afford to have deaths, painful and costly hospitalisations, disruptions to work and school from a completely vaccine-preventable disease.” Ninety per cent of European cases were amongst adolescents and adults who had not been vaccinated or people where it was not known if they had been vaccinated or not. And measles from Europe has been linked to outbreaks in several other countries including Brazil, Canada and Australia.

‘Potential danger’

Zsuzsanna Jakab, WHO regional director for Europe, said: “The increase in measles in European countries reveals a serious challenge to achieving the regional measles elimination goal by 2015.

“Every country in the European region must take the opportunity now to raise coverage amongst susceptible populations, improve surveillance and severely reduce measles virus circulation before the approaching measles high season.”    A spokeswoman for the Health Protection Agency, which covers England and Wales, said: “Anyone who missed out on MMR as a child will continue to be at risk of measles, which explains why we are continuing to see cases in a broad age range.”     “We are again reminding parents and young adults of the importance of immunisation. We cannot stress enough that measles is serious and in some cases it can be fatal.”  “Measles is a highly infectious and potentially dangerous illness which spreads very easily. Whether you stay here in the UK or travel abroad it is crucial that individuals who may be at risk are fully immunised.” 

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Genetically altered mosquitoes: a tale of two headlines

Andrew Pollack, writing in the print editions of The  New York Times wrote  “Mosquito Bred to Fight Dengue Fever Shows Promise in Field Trial,” published on October 31st, 2011. We’ve been planning on switching to an all-digital subscription, but haven’t sorted out yet which plan. So we’ve often got hard copy (i.e. the print edition) in the house, often with notes about posting. But in order to reduce transcription error, and speed things up, our posts will be based on the digital edition. However, in this case searching for Pollack’s 31 October piece, we found Concerns Raised about Genetically Engineered Mosquitoes, dated 30 October 2011. An initial line-by-line comparison of the two  pieces (the first few grafs) suggest they’re close, if not identical.There’s nothing sinister happening here; it may merely be that, after posting the piece on NYTimes.com, editors thought better of the headline. (If you’re confused about the sequence, bear in mind that the earlier piece, which made print editions dated 31 October, had to be committed to print on the evening of the 30th; the on-line edition may have been originally posted on the 30th, but revised any number of times since its posting.

 

Reseaarchers on Sunday reported initial signs of success from the first release into the environment of mosquitoes engineered to pass a lethal gene to their offspring, killing them before they reach adulthood. The results, and other work elsewhere, could herald an age in which genetically modified insects will be used to help control agricultural pests and insect-borne diseases like dengue fever and malaria. But the research is arousing concern about possible unintended effects on public health and the environment, because once genetically modified insects are released, they cannot be recalled. Authorities in the Florida Keys, which in 2009 experienced its first cases of dengue fever in decades, hope to conduct an open-air test of the modified mosquitoes as early as December, pending approval from the Agriculture Department. “It’s a more ecologically friendly way to control mosquitoes than spraying insecticides,” said Coleen Fitzsimmons, a spokeswoman for the Florida Keys Mosquito Control District. The Agriculture Department, meanwhile, is looking at using genetic engineering to help control farm pests like the Mediterranean fruit fly, or medfly, and the cotton-munching pink bollworm, according to an environmental impact statement it published in 2008. Millions of genetically engineered bollworms have been released over cotton fields in Yuma County, Ariz. Yet even supporters of the research worry it could provoke a public reaction similar to the one that has limited the acceptance of genetically modified crops. In particular, critics say that Oxitec, the British biotechnology company that developed the dengue-fighting mosquito, has rushed into field testing without sufficient review and public consultation, sometimes in countries with weak regulations.

More from Pollacs’s piece (both versions):

Dr. Alphey said the technique was safe because only males were released, while only females bite people and spread the disease, adding that it should have little environmental impact. “It’s exquisitely targeted to the specific organism you are trying to take out,” he said.

The company is focusing on dengue fever rather than malaria because a single mosquito species is responsible for most of its spread, while many species carry malaria. Also, unlike for malaria, there are no drugs to treat dengue, and bed nets do not help prevent the disease because the mosquito bites during the day. There are 50 million to 100 million cases of dengue each year, with an estimated 25,000 deaths. The disease causes severe flulike symptoms and occasionally, hemorrhagic fever. The Oxitec technique, however, is not foolproof. Alfred M. Handler, a geneticist at the Agriculture Department in Gainesville, Fla., said the mosquitoes, while being bred for generations in the lab, can evolve resistance to the lethal gene and might then be released inadvertently.

Todd Shelly, an entomologist for the Agriculture Department in Hawaii, said in a commentary published on Sunday by Nature Biotechnology that 3.5 percent of the insects in a lab test survived to adulthood despite presumably carrying the lethal gene.

Also, the sorting of male and female mosquitoes, which is done by hand, can result in up to 0.5 percent of the released insects being female, the commentary said. If millions of mosquitoes were released, even that small percentage of females could lead to a temporary increase in disease spread.

Oxitec and a molecular biologist, Anthony A. James of the University of California, Irvine, say they have developed a solution — a genetic modification that makes female mosquitoes, but not males, unable to fly. The grounded females cannot mate or bite people, and separating males from females before release would be easier.

In a test in large cages in Mexico, however, male mosquitoes carrying this gene did not mate very successfully, said Stephanie James, director of science at the Foundation for the National Institutes of Health, which oversaw the project.

Experts assembled by the World Health Organization are preparing guidelines on how field tests of genetically modified insects should be conducted. Proponents hope the field will not face the same opposition as biotechnology crops.

See also

BBC – E. Coli outbreak waning

According to the BBC, the European E. Coli episode is winding down:

Germany’s health minister says new E. coli infections from a deadly outbreak are dropping significantly and the worst of the illness is over. Daniel Bahr said he was cautiously optimistic the outbreak had peaked, but warned that more deaths were expected as new cases emerged each day.

The outbreak has so far left 24 dead, infected 2,400 and left hundreds with a complication that attacks the kidneys.   Earlier, the EU proposed 150m euros (£134m) of compensation for farmers.But agriculture ministers said they wanted much more and that their producers of fruit and vegetables should be compensated for the full amount of their losses, estimated at up to 417m euros (£372m) a week.

The outbreak was wrongly blamed on Spanish cucumbers last week by the health authorities in northern Germany, the centre of the outbreak. Investigators are still trying to find the real origin of the new strain of enterohaemorrhagic E. coli (EHEC). New cases are still being reported every day, including 94 in Germany on Tuesday.

For further reference, see the World Health Organization’s Enterohaemorrhagic Escherichia coli (EHEC) Fact Sheet, and the relevant Wikipedia entry,Escherichia_coli_O157:H7.

Three Cases of Cholera Confirmed by City Officials – NYTimes.com

Cholera Bacteria viewed in electron microscope. From Dartmouth University via Wikimedia Commons

By AL BAKER on The CityRoom blog at NYTimes.com:

The first known cases of cholera in New York since the outbreak of the disease in Haiti last year were confirmed on Saturday by city officials.A commercial laboratory notified health officials on Friday that three New Yorkers had developed diarrhea and dehydration, classic symptoms of the disease, after returning from a wedding on Jan. 22 and 23 in the Dominican Republic, where the government has been trying to prevent the disease from spreading from neighboring Haiti.The three who contracted cholera were adults who returned to the city within days of the wedding.None were hospitalized. Continue reading →