[Health] The Infectious Diseases Thread

[coopasonic]

We have a rabies manual that's about as thick as a telephone book (ask your parents)

Just to be clear, we are the parents.

[Isgrimnur]

Hmnmm....I guess that's a monster report, but at least here in the NE that's been our message for at least the last 15+ years. Our last case of wild canine rabies was in the 1950s and then it disappeared for a while. Eventually it came back to the state via raccoons and now we believe bats are the primary carrier. I've lost track of the number of phone calls I've had over bats in the house - probably over a hundred during my relatively short time. We have a rabies manual that's about as thick as a telephone book (ask your parents) on how to deal with any type of permutation of human/animal or animal/animal interaction (with respect to rabies, you pervs). One of the towns I was working in even had a rabid cow - worst Steven King movie ever. Anyway, I hadn't seen this monster report, so thanks for the signal boost.

Define, "monster report."

[Smoove_B]

Define, "monster report."

The one that cover 80 years of data. I'm only used to reading annual (federal) summaries and similar local reports. Monster in scope, not printed length.

[Smoove_B]

Just to be clear, we are the parents.

Maybe. Probably? I didn't want to assume.

[Isgrimnur]

Define, "monster report."

The one that cover 80 years of data. I'm only used to reading annual (federal) summaries and similar local reports. Monster in scope, not printed length.

Thank you. I knew I was missing something when it came out to six pages.

[hitbyambulance]

Just to be clear, we are the parents.

Maybe. Probably? I didn't want to assume.

with no fresh blood, this board has become increasingly (geometrically? exponentially?) geriatric over the past decade. assume away.

[coopasonic]

Just to be clear, we are the parents.

Maybe. Probably? I didn't want to assume.

with no fresh blood, this board has become increasingly (geometrically? exponentially?) geriatric over the past decade. assume away.

Hopefully the progression has been linear. If you are aging geometrically or exponentially you may want to see a physician... or possibly a physicist.

[Smoove_B]

NY ends religious exemptions for vaccination:

New York Gov. Andrew Cuomo signed a bill Thursday ending vaccination exemptions based on religious beliefs, the latest attempt to address the growing measles outbreak, the worst the U.S. has experienced in decades.

Cuomo said plugging the loophole should help contain the spike in measles cases in New York, the state the hardest hit by the uptick in the contagious virus due to low vaccination rates in ultra-Orthodox communities.

"The science is crystal clear: Vaccines are safe, effective and the best way to keep our children safe," Cuomo said after signing the bill. "While I understand and respect freedom of religion, our first job is to protect the public health and by signing this measure into law, we will help prevent further transmissions and stop this outbreak right in its tracks."

Details for those that like them:

The New York Assembly narrowly passed the bill by a 77-53 vote. It needed 76 votes for passage. Lawmakers in the state Senate advanced the measure by a tally of 36-26.

A small number of other states including California, Mississippi and Arizona have already passed laws banning vaccine exemptions on religious grounds.

[Isgrimnur]

And I'm sure the current Supreme Court will love to hear this case down the road. If religious freedom trumps public safety...

[Smoove_B]

They already heard it in 1905 and ruled:

Upon the principle of self-defense, of paramount necessity, a community has the right to protect itself against an epidemic of disease which threatens the safety of its members.

Historically (and broadly) courts generally side with public health, so yeah, let's see what happens.

[Isgrimnur]

Well, there are many groups chomping at the bit to overturn settled precedence these days.

[Smoove_B]

Just in time for summer, your annual update on Vibro vulnificus, via Time:

Climate change is warming ocean waters around the globe, which affects what can thrive in various parts of the seas. Now, bacteria that can cause a flesh-eating infection are showing up in waters once too cold to harbor them.

A new report published in the Annals of Internal Medicine links five recent cases of Vibrio vulnificus to the Delaware Bay, bordered by New Jersey and Delaware. These bacteria live in brackish water—a mix of salty and fresh, often where a river meets a sea. Historically, in the U.S., V. vulnificus have mostly been found in the southeastern part of the country.

“We were all very surprised and puzzled that there were a significant number of cases of this infection that we hadn’t seen before,” says Dr. Katherine Doktor, co-author of the report and an infectious disease specialist at Cooper University Hospital in New Jersey. In the eight years before 2017, the hospital had only seen one case of the infection, but in 2017 and 2018, it saw five total.

What's the message?

Doktor says that people don’t need to avoid all bodies of water in the summer in fear of the bacteria—but they should be aware of the risks and take extra precautions. “If people have risk factors and they do sustain cuts that are not getting better” Doktor says, “they should see a healthcare provider.”

[Jeff V]

Doesn't the New Jersey welcome sign already contain the tag line "Home of the Flesh Eating Bacteria"?

[Kraken]

I would hire Dr. Doktor.

[Blackhawk]

I would hire Dr. Doktor.

She'd give you the news - a joke I'm sure she's never heard.

[Freyland]

I have a Dr. Doctor in my extended hospital system that I get to interact with occasionally. He does not like to be called that.

[Smoove_B]

How does he react when you ask him to give you the news? Does he indicate then that he does not have a bad case of loving you?

[Blackhawk]

But if you just call him 'Doctor', how does he know whether you are being formal or talking down to him?

[Freyland]

He wants to be called by his first name, which I feel is less respectful, but it's his call.
Smoove, almost always when I call him it's because I need advice or to transfer a patient to his care, so generally that would be suicidal. That said, if I get a chance to call him about getting an update, it might be fun to slip "give me the news" in there anyways.

[Smoove_B]

Not quite the same, but I've had the scene from Spies Like Us in my head all morning.

[Isgrimnur]

CDC

Cryptosporidium is the leading cause of outbreaks of diarrhea linked to water and the third leading cause of diarrhea associated with animal contact in the United States.
...
During 2009–2017, 444 cryptosporidiosis outbreaks, resulting in 7,465 cases were reported by 40 states and Puerto Rico. The number of reported outbreaks has increased an average of approximately 13% per year. Leading causes include swallowing contaminated water in pools or water playgrounds, contact with infected cattle, and contact with infected persons in child care settings.

[Isgrimnur]

MRSA

University of Pittsburgh Medical Center Children's Hospital confirmed on Monday 12 cases of a drug-resistant staph infection in its neonatal intensive care unit (NICU), according to a statement from the hospital.

The six babies, including one who is potentially symptomatic, and six symptomatic employees who have tested positive for Methicillin-resistant Staphylococcus aureus (MRSA) are being treated, UPMC said.
...
An estimated 119,247 staph bloodstream infections were seen in 2017, which resulted in 19,832 deaths, according to a recent CDC report. From 2005 to 2013, the rates of MRSA bloodstream infections diagnosed in hospitals declined on average 17.1% every year, however no significant change in infection rates has been observed since, the CDC says.
...
UPMC noted that a portion of the population carry MRSA without ever being symptomatic. While one in three people carry the Staphylococcus aureus bacteria in their noses, most do not get sick, according to the CDC.

[em2nought]

Leading causes include swallowing contaminated water in pools or water playgrounds, contact with infected cattle, and contact with infected persons in child care settings.

I'd have guessed Taco Bell would have made it onto that list.

[Pyperkub]

Leading causes include swallowing contaminated water in pools or water playgrounds, contact with infected cattle, and contact with infected persons in child care settings.

I'd have guessed Taco Bell would have made it onto that list.

Their hotel is new. Just give it a few months.

[Isgrimnur]

How do you say Legionnaires' in Spanish?

[Smoove_B]

Las bacterias Legionella pueden causar un tipo grave de neumonía (infección de los pulmones) llamado enfermedad del legionario. Estas bacterias también pueden causar una enfermedad menos grave llamada fiebre de Pontiac.

[Isgrimnur]

[gilraen]

Their hotel is new. Just give it a few months.

Taco Bell Hotel is a pop-up promotion, it'll only be around for 4 days

[em2nought]

Their hotel is new. Just give it a few months.

Taco Bell Hotel is a pop-up promotion, it'll only be around for 4 days

Four days is plenty of time, it only takes the restaurants about twenty minutes judging by my internal clock.

[Isgrimnur]

CNN

Three guests who stayed at a prominent downtown Atlanta hotel have become sick with Legionnaires' disease, prompting an investigation of the hotel on Monday, officials said.

"Based on epidemiological evidence we have an outbreak among people who stayed at the [Sheraton Atlanta] during the same time period," said Nancy Nydam, director of communications at Georgia Department of Public Health, on Tuesday.
...
The bacterium causing Legionnaires' has not yet been confirmed at the hotel, which has hired outside experts to conduct testing.

The hotel has voluntarily shuttered its doors until the source of infection is found and remediation is complete, Nydam said. More than 400 guests have been relocated to nearby hotels, CNN affiliate WSB-TV reported.

[Isgrimnur]

North Carolina

An Ohio teenager died after contracting a suspected brain-eating amoeba infection while visiting the U.S. National Whitewater Center in Charlotte last week, according to health officials.

North Carolina

North Carolina health officials say a person has died from a rare brain-eating amoeba after swimming in a manmade lake at a water park.

The state Department of Health and Human Resources said in a news release Wednesday that the infection was caused by the amoeba naturally present in warm freshwater during the summer. The unnamed person became sick after swimming in Fantasy Lake Water Park in Cumberland County on July 12.

The federal Centers for Disease Control and Prevention confirmed it was caused by Naegleria fowleri, a single-celled organism known as the brain-eating amoeba. It can be fatal if forced up the nose.
...
Health officials say the amoeba is known to have infected just 145 people in the U.S. from 1962 through 2018.

There goes my play to start an amoeba-snorting fad.

[Isgrimnur]

Almost everywhere

Two people are dead and 768 are ill due to a nationwide Salmonella outbreak,the Centers for Disease Control and Prevention reported.

The CDC recently posted updates regarding two separate outbreaks – one linked to contact with poultry in backyard flocks and one linked to contact with pig ear dog treats.

According to the latest CDC report, the outbreak now involves 48 states with 768 people affected — 122 of them hospitalized. Two deaths were reported, one in Texas and one in Ohio.
...
In Tennessee, 55 people have become ill. The only other state to report more cases is Ohio, with 62 illnesses.

[Isgrimnur]

Eastern Equine Encephalitis,

CNN

Florida health officials are warning of an uptick in a mosquito-borne virus known as Eastern equine encephalitis (EEE).

Several sentinel chickens tested positive for EEE, which can spread to humans via infected mosquitoes and cause brain infection and swelling, the Florida Department of Health in Orange County said in a Thursday statement. Sentinel chickens are fowl that are tested regularly for the West Nile virus and EEE. Their blood can show the presence of the diseases, but they don't suffer from the effects of the viruses.

Following the positive tests for the sentinel chickens in Orange County, the health department said "the risk of transmission to humans has increased."

Only about seven cases of the EEE virus in humans are reported in the US each year, the Centers for Disease Control and Prevention says.

However, the disease can be fatal: about 30% of people who contract it die, according to the CDC. Many survivors have ongoing neurologic problems.

People develop symptoms about 4 to 10 days after they are bitten by an infected mosquito, the CDC says. Signs include sudden onset of headache, high fever, chills and vomiting. More severe symptoms include disorientation, seizures and coma.

[Isgrimnur]

Algal blooms

Dog owners in the Southeast are spreading the word about the dangers of contaminated water following the deaths of their beloved pets.

In Wilmington, North Carolina, three dogs died after frolicking in a pond, while another succumbed after a swim in Lake Allatoona, Georgia. A common enemy likely led to the deaths of all four dogs: liver failure brought on by ingesting water contaminated with toxic blue-green algae.
...
Toxic algae can also grow in decorative ponds as well as backyard pools, providing homeowners with a good reason to properly sanitize swimming water.
...
Toxic algae often stink, sometimes producing a downright nauseating smell, yet animals may be attracted to the smell and taste of them, according to the EPA.

Symptoms, which usually arise anywhere from 15 minutes to several days after exposure, include diarrhea or vomiting, weakness or staggering, drooling, difficulty breathing and convulsions or seizures, the EPA reports.
...
One study identified 368 cases of toxic algae poisoning associated with dogs throughout the US over a nine-decade period, but the researchers believe this represents only "a small fraction of cases that occur throughout the US each year."

[Isgrimnur]

C. diff.

Here, we show that the spore-forming, healthcare-associated enteropathogen Clostridium difficile is actively undergoing speciation. Through large-scale genomic analysis of 906 strains, we demonstrate that the ongoing speciation process is linked to positive selection on core genes in the newly forming species that are involved in sporulation and the metabolism of simple dietary sugars. Functional validation shows that the new C. difficile produces spores that are more resistant and have increased sporulation and host colonization capacity when glucose or fructose is available for metabolism. Thus, we report the formation of an emerging C. difficile species, selected for metabolizing simple dietary sugars and producing high levels of resistant spores, that is adapted for healthcare-mediated transmission.

[The Meal]

MHS has been dealing with some extra super bug c. diff for most of 2019 (as an outcome of her adventures in 2018, no doubt).

No. Fun.

[Smoove_B]

For those that were wondering if there was ever going to be a follow-up to Texas ultimately not requiring an HPV vaccination for children:

In 2007, two governments set into motion a massive public health experiment.

One was the state of Texas, where lawmakers rejected a mandate to vaccinate adolescent girls against human papillomavirus, or HPV, a near-ubiquitous sexually transmitted infection that causes cervical cancer. For more than a decade since, the number of Texas adolescents vaccinated against HPV has remained low.

On the other side of the globe, Australia, a country with roughly the same size population and economy as Texas, was taking a radically different approach. Public health leaders there rolled out a nationwide program that offered the HPV vaccine to girls for free at their schools. The program, though optional, proved popular, and it later expanded to boys. Vaccine coverage grew rapidly, with up to 80% of teens becoming immunized over the next decade.

Now, 12 years after Texas and Australia first veered onto wildly different courses regarding HPV prevention, their gap in health outcomes has widened demonstrably. Australia is on track to become the first country to eliminate cervical cancer, perhaps within a decade. Texas, meanwhile, has hardly made a dent in its rate of cervical cancer — which remains one of the highest in the United States, with an incidence comparable to that of some developing countries.

What happened?

On a Friday afternoon in February 2007, just months after the U.S. government approved a vaccine to protect adolescent girls against HPV, then-Gov. Rick Perry — a Republican — stunned the political establishment by announcing an executive order: Texas would become the first state in the nation to require all 11- and 12-year-old girls entering the sixth grade to receive the vaccination. Doing so, Perry wrote, had “the potential to significantly reduce cases of cervical cancer and mitigate future medical costs.”

...

Their optimism was short-lived. Pressure from evangelical groups and members of a nascent anti-vaccine political movement to repeal the executive order mounted, while government watchdogs accused the Texas governor of being too cozy with pharmaceutical lobbyists; his former chief of staff, Mike Toomey, had gone on to become a lobbyist for Merck, the manufacturer of the Gardasil HPV vaccine.

Within weeks, Texas lawmakers revolted against Perry’s order — and with support from Democrats and Republicans, the Legislature voted overwhelmingly to torpedo the mandate.

“We did not want to be the first in offering young girls for the experiment to see if this vaccine is effective or not,” state Rep. Dennis Bonnen, the Angleton Republican who authored the bill overturning Perry’s order, told The New York Times. (Bonnen, now the Texas House Speaker, did not respond to emailed questions.)

.

[Isgrimnur]

WebMD

An antibiotic-resistant strain of salmonella is sickening people who eat contaminated beef and unpasteurized soft Mexican cheese, U.S. health officials warned Thursday.

First seen in 2017, this bacterial strain has already caused 255 Americans in 32 states to become ill, and many more cases are expected.

The U.S. Centers for Disease Control and Prevention has pinpointed the source to contaminated beef from U.S. sources and soft Mexican cheese, which suggests that cattle in both countries are infected.

"The resistant strains developed in animals, and those strains can then be transmitted to humans," explained lead researcher Dr. Ian Plumb, a CDC medical epidemiologist.
...
This latest strain of salmonella is resistant to two commonly prescribed antibiotics, namely azithromycin and ciprofloxacin, the CDC found.

Among the 255 patients, 60 were hospitalized and two died, Plumb said. The patients who died had other illnesses, but salmonella was a factor in their deaths, he said.
...
Plumb said that the CDC wasn't able to hone in on any particular brands of beef, but the agency suspects that this strain of salmonella will continue to spread among cattle.

[Isgrimnur]

Stat News

HPV gives 34,800 Americans cancer every year, according to the Centers for Disease Control and Prevention. Of those, 20,700 are women and 14,100 are men. In men, the most common HPV-caused cancer is the one Becker had: cancer of the mouth and throat. Most frequently, it’s probably transmitted through oral sex (HPV is sexually transmitted), although it could be caught in other ways, perhaps even occasionally through kissing. There are an estimated 13,500 cases of HPV oropharynx cancer each year. Of these, 11,300 are in men.
...
Results published Tuesday in the Journal of the American Medical Association represent Gillison’s effort to do the next best thing. She conducted a study to see if the introduction of Gardasil resulted in a reduction of the likelihood of HPV infection not in people who got the vaccine, but in men who didn’t.

Between 2009 and 2016, vaccination rates in Gillison’s sample of men increased from 0% to 5.8%. During that time, the prevalence of the HPV strains included in the vaccine, which are among those most likely to cause cancer, declined 37% in unvaccinated men — those strains went from infecting 2.7% of unvaccinated men to 1.6% of unvaccinated men. Those results would be even stronger if more boys and men were vaccinated, she said. “This story makes a lot of sense,” said Dr. Otis Brawley, the Bloomberg distinguished professor at the Johns Hopkins School of Public Health. “It is evidence that the HPV vaccine in boys and girls will prevent head and neck cancer in the future.”

[Isgrimnur]

Brain-eating amoeba

An elementary school student in Texas died after contacting a brain-eating amoeba while swimming in a local lake, her family confirmed. CBS affiliate KWTX-TV reports that 10-year-old Lily Mae Avant died early Monday after being hospitalized at Cook Children's Hospital in Fort Worth over the past week.

According to KWTX, officials believe Lily contracted the brain-eating amoeba after swimming in the Brazos River over Labor Day weekend. Lily apparently fell ill with a headache and fever last weekend after swimming.

Doctors at Cook Children's determined she was suffering from primary amebic meningoencephalitis (PAM), which is an infection to the brain caused by the amoeba Naegleria fowleri, CBS Dallas/Fort Worth reports.
...
Only four people in the United States out of 143 have survived infection from 1962 to 2017, according to the CDC. The amoeba affects people when contaminated water enters the body through the nose and works its way into the brain. A person cannot get infected from swallowing water contaminated with Naegleria fowleri.