[Health] The Infectious Diseases Thread

[Isgrimnur]

Whats a MSM community?

Men who have sex with men

[Smoove_B]

Since you like acronyms, the WHO has declared monkeypox a PHEIC.

From Reuters:

The rapidly spreading monkeypox outbreak represents a global health emergency, the World Health Organization's highest level of alert, WHO Director-General Tedros Adhanom Ghebreyesus said on Saturday.

The WHO label - a "public health emergency of international concern" - is designed to sound an alarm that a coordinated international response is needed and could unlock funding and global efforts to collaborate on sharing vaccines and treatments.

Members of an expert committee that met on Thursday to discuss the potential recommendation were split on the decision, two sources who spoke on the condition of anonymity told Reuters earlier, but the final decision falls to the U.N. agency's director-general.

Announcing his decision to declare the health emergency during a media briefing in Geneva, Tedros confirmed that the committee had failed to reach a consensus, with nine members against and six in favour of the declaration.

Previously, Tedros has typically endorsed expert committee recommendations, but the sources said he had likely decided to back the highest alert level due to concerns about escalating case rates and a short supply of vaccines and treatments, despite the lack of a majority opinion.

Why is the PHEIC declaration notable?

Until now, the label had only been applied to the coronavirus pandemic and ongoing efforts to eradicate polio.

[Chraolic]

Since you like acronyms, the WHO has declared monkeypox a PHEIC.

Did they have to choose an acronym that's pronounced like "fake"? That's really not helping science.

[Smoove_B]

Word on the street is that we're going to need a dedicated Monkeypox thread, likely R&P.

[Daehawk]

Polio in NY

[Smoove_B]

That was last week, my dude - things are moving quickly.

I didn't even mention melioidosis in the Gulf Coast area of Mississippi yet.

[Isgrimnur]

I didn't even mention melioidosis in the Gulf Coast area of Mississippi yet.

[coopasonic]

Word on the street is that we're going to need a dedicated Monkeypox thread, likely R&P.

My wife told me they are starting to see Monkeypox cases at her hospital. She asked me again when she gets to quit. Realistically with the house paid off and her investments she doesn't need to work but with the uncertainty in the economy I am not 100% comfortable going with one income (despite being an experienced developer in current technologies with leadership experience that doesn't require sponsorship).

[Smoove_B]

They were vaccinating front-line healthcare workers in MA last month against it; I'd hope they have similar plans at your wife's hospital. All of this continues to be surreal to me, as I still remember the 2003 outbreak here in the U.S. (Texas, ironically) and how it was a non-event.

I met a few hospital ER nurses over the last two years that left the field to become school nurses - it's a different kind of crazy environment but overall probably less stress and better hours.

[coopasonic]

They aren't offering it currently.

[Smoove_B]

That might change in the next 48 hours. Maybe not to all staff, but it won't surprise me if they create dedicated teams that are vaccinated.

[LawBeefaroni]

Our hospital COVID updates have been rebranded as Infectious Disease updates since we're in a multi threat environment. We are being told to expect to see an influx of monkeypox cases. Med Dir reiterated that while it's most prevalent in MSM communities that it is not an STD or limited to MSMs. Also warned against stigmatizing, because apparently that's happening elsewhere. Also went into PPE recommendations. Essentially keep doing what you're doing for COVID (masks, gloves).


I was surprised to learn that COVID isn't over. Who knew?

[Smoove_B]

That's good to hear because anecdotally getting tested if you're not someone that immediately identifies as a MSM has been problematic - and likely making things much much worse (in terms of identifying and stopping community spread).

CNN story here:

Mayo Clinic Laboratories, for example, has the capacity to process 1,000 monkeypox samples a week but has received only 45 specimens from doctors since starting monkeypox testing July 11. Another of the labs, Aegis Sciences Corp., can do 5,000 tests per week but has received zero samples over the past two weeks. At Labcorp, one of the largest commercial labs in the US, uptake has been higher but still "extremely low," according to Dr. Brian Caveney, the lab's president of diagnostics.

[Smoove_B]

I'm a little surprised to read this from NY state, but it should be noted:

ALBANY, N.Y. (August 1, 2022) – The New York State Department of Health (NYSDOH) today updated New Yorkers on polio in New York State. Following the identification of a case of polio in a Rockland County resident, NYSDOH launched wastewater surveillance, among other detection efforts, to check for signs of the virus. Following analysis from the Centers for Disease Control and Prevention (CDC), the polio virus was detected in samples from June in Rockland County. These findings underscore the critical importance of vaccination to protect all New Yorkers and New York children against polio.

"Polio is a dangerous disease with potentially devastating consequences," State Health Commissioner Dr. Mary T. Bassett said. "In the United States, we are so fortunate to have available the crucial protection offered through polio vaccination, which has safeguarded our country and New Yorkers for over 60 years. Given how quickly polio can spread, now is the time for every adult, parent, and guardian to get themselves and their children vaccinated as soon as possible."

As part of ongoing surveillance efforts, New York wastewater samples are shared with the Global Polio Laboratory Network (GPLN), which includes CDC and the World Health Organization (WHO). GPLN confirmed that the case in New York is genetically linked to two Sabin-like type 2 (SL2) isolates, collected from the early June samples from Rockland County and samples from greater Jerusalem, Israel as well as to the recently-detected VDPV2 from environmental samples in London, UK. New Yorkers should know that this does not imply that the individual case identified in New York has travel history to Israel or the UK.

The take home message:

All New Yorkers who are unvaccinated, including children 2 months and older, those who are pregnant, and people who have not completed their polio vaccine series previously, should get vaccinated right away. Unvaccinated New Yorkers who live, work, go to school in, or visit Rockland County are at the highest risk of exposure. Rockland County currently has a polio vaccination rate of 60.5% among two year-olds compared to the statewide average of 79.1%.*

[Smoove_B]

Not really sure why it took so long, but Monkeypox outbreak has officially been declared a public health emergency in the United States:

The public health emergency declaration comes nearly two weeks after the World Health Organization declared the unprecedented international spread of the virus a public health emergency of international concern. The outbreak, first detected in the United Kingdom in mid-May, has now seen more than 26,000 cases recorded by more than 80 countries around the globe. More than 6,600 of those cases have been recorded in the U.S.

The declaration of a domestic public health emergency gives the administration more flexibility and powers with which to try to halt spread of the virus. The powers could, among other things, allow the administration to tap into additional federal funds for the response.

Also Thursday, FDA Commissioner Robert Califf announced the agency was considering allowing Bavarian Nordic’s Jynneos, the only vaccine licensed in the United States to prevent monkeypox, to be given in two doses that are one-fifth the size of the licensed doses, via intradermal administration. Doing so could allow five times as many people to be vaccinated with existing supplies than if the licensed dosage was employed.

The vaccine is licensed as a two-dose product, with the doses administered via intramuscular injection 28 days apart.

“We believe this could be a promising approach,” Califf said.

[Max Peck]

Fecal fountains: CDC warns of diarrheal outbreaks linked to poopy splash pads

In this summer's record-blazing heat, a spritz of crisp, cool water sounds like delicious bliss. Each drop offering brisk relief as it pitter-patters on your face, quenching your sizzling skin.

But if you find such euphoric respite at a children's splash pad, that soothing spray could quickly turn to a sickening spew, as the drips and drops may be doused with diarrheal pathogens. Each patter may offer a splat of infectious germs that, if accidentally ingested, could transform you into a veritable fecal fountain in the ensuing days.

That's the warning from the Centers for Disease Control and Prevention, at least. This week the agency published a report outlining two gastrointestinal outbreaks linked to a single recreational splash pad in Kansas. The two outbreaks, which occurred days apart in June 2021, involved two different pathogens—Shigella bacteria and norovirus—and collectively sickened at least 27 people. Although some circumstances are specific to that particular splash pad in Kansas, the outbreaks highlight the common risk of such facilities, which are often unregulated.

[Daehawk]

I dont trust anything where kids are around it.

[Smoove_B]

The kiddie pools (splash pools, wading pools) at any of the places I've inspected were always a nightmare. Had to close them all the time as they were usually fecal nightmares.

In other not-great children news in NYC:

Our new map shows polio vaccination rates for NYC children 6 months to 5 years old. According to our data, 13.8% have not been vaccinated against polio. Polio is highly contagious. The most important way to prevent polio is by getting vaccinated.

This has some real potential to get ugly when you drill down into the data and see that in some areas it's close to 50% unvaccinated; it's mind-boggling.

[Isgrimnur]

[Max Peck]

Langya: New virus infects 35 people in eastern China

Scientists are tracking a new, animal-derived virus in eastern China that has infected at least several dozen people.

The novel Langya henipavirus (LayV) was found in 35 patients in the Shandong and Henan provinces. Many had symptoms such as fever, fatigue and a cough.

They are thought to have contracted the virus from animals. There is no evidence so far LayV can transmit among humans.

Researchers detected the virus predominantly in shrews.

The discovery was highlighted in a letter written by researchers from China, Singapore and Australia and published in the New England Journal of Medicine this month.

One of the researchers, Wang Linfa from the Duke-NUS Medical School in Singapore, told China's state-run Global Times that the cases of LayV found so far have not been fatal or very serious, so there is "no need to panic".

[Blackhawk]

Add to bunker: One large, bunker-sized, positive-pressure bubble.

[Smoove_B]

Yeah, I saw that yesterday. It's a virus in the same family as the Nipah virus, one we've been watching for years. I can't say I'd heard of this one before the news release.

[Smoove_B]

And since everyone is asking, this piece in Wired is probably the best summary I've seen so far regarding the possible future of Monkeypox. In short the three paths we can opt for:

Choice 1: The Boldest Path

Here’s the best possible future: The world learns the lessons of Covid and does everything to stop this next threat.

Choice 2: The Mushy Middle

This maintains the status quo: distributing vaccines, but not to everyone who wants one. Deploying tests, but not rapidly, because the current assay can’t be used until an infected person develops the characteristic pustules. Dispensing drugs, but only after asking prescribers to vault bureaucratic hurdles imposed by the only available treatment being held in a federal stockpile.

Choice 3: The Dead End

Then there’s the worst case: We don’t control monkeypox. In this imagined future, monkeypox slips through the imperfect containment created by insufficient vaccine supplies, leaking from the social networks of men who have sex with other men, through other sexual partners and members of households, and into the rest of society—particularly people with vulnerable immune systems, including older folks, pregnant people, and kids.

I think the United States is squarely in Choice 2 right now, trending towards Choice 3. It's beyond frustrating.

[LawBeefaroni]

Will it be too late in a year when monkeypox has come out of nowhere and completely blindsided everyone? I mean that's probably a good time to contain it, right?

[Smoove_B]

Will it be too late in a year when monkeypox has come out of nowhere and completely blindsided everyone? I mean that's probably a good time to contain it, right?

Seriously, what's the rush? We have learned nothing - nothing.

There's another article I was reading this morning demonstrating how the disease etiology has changed since leaving Africa and we're not really sure why or how.

In some ways, the virus is acting differently than it has in the past. For decades, researchers in West and Central Africa, where the virus is endemic, have observed that outbreaks there tend to be self-limiting. A single case or small cluster would pop up occasionally, caused by hunting and handling infected animals or being bitten by one, but those spillover events rarely kicked off long chains of transmission within communities.

As researchers rush to understand exactly what is different about this global outbreak, they’re finding that for the most part, monkeypox is still the same it’s always been. The mechanisms of how it moves from host to host remain unchanged. What’s different is the environment and the social networks monkeypox now finds itself in.

It's yet another situation where scientists and researchers have been sounding the alarm for decades now, but until it left Africa no one would listen. Our experience in 2003 (when there were < 50 domestic cases) arguably made it worse as I'm confident everyone thought it wouldn't be a problem considering how quickly and easily it was addressed ~20 years ago.

Similar to Ebola, it wasn't a problem until it was a problem.

[Isgrimnur]

Add to bunker: One large, bunker-sized, positive-pressure bubble.

Not going to help, giving how bad Indiana sucks.

[The Meal]

“ CDC ends recommendations for social distancing and quarantine for Covid-19 control, no longer recommends test-to-stay in schools”

CNN headline

[Smoove_B]

The @CDCgov doubles down on its flawed, not evidence based Covid recommendations with a new guidance document
1. Leaves fully vaccinated = 2 shots, stay "up to date"
2. Leaves isolation at 5 days w/o rapid tests
3. Pushes "community levels" when real info is "transmission levels"

[$iljanus]

The kiddie pools (splash pools, wading pools) at any of the places I've inspected were always a nightmare. Had to close them all the time as they were usually fecal nightmares.

In other not-great children news in NYC:

Our new map shows polio vaccination rates for NYC children 6 months to 5 years old. According to our data, 13.8% have not been vaccinated against polio. Polio is highly contagious. The most important way to prevent polio is by getting vaccinated.

This has some real potential to get ugly when you drill down into the data and see that in some areas it's close to 50% unvaccinated; it's mind-boggling.

COVID delaying pediatric visits for your regularly scheduled immunizations really screwed things up so I'm not surprised. They better get a handle on that before school starts. I'll make the optimistic assumption that parents won't hesitate to get their kids vaccinated for polio. Just break out pictures of iron lung machines to motivate them. I also assume that NYC requires your typical childhood vaccinations before being admitted to school.

Ouch, Rockland County just north of the city is dismal

https://arstechnica.com/science/2022/08 ... -infected/

Edit: So as I dive deeper into this and Smoove can correct or add as needed, patient zero was most likely the person who came down with polio in Rockland County recently. It was genetically tied to a viral variant which arises from people vaccinated with an oral vaccine that has the weakened virus. In rare instances that person can shed the virus. Two things to keep in mind however! One, the US does not use weakened virus in the polio vaccine. So if you have a family member who starts spouting shit about how you can get polio from the vaccine point out this little tidbit (Let’s just say I’m going to a family function where the understanding of science is, um, not so much) Two, this would not be a problem if the surrounding community had a high vaccination rate because the shed virus after tasting freedom would have no one to infect. Unfortunately due to low vaccination rates in the community in Rockland however…(at this point in the family conversation I may get a response about how they have done their research. Due to the lack of alcohol at these functions that will be the signal for me to call for my daughter and say it’s time to go… )

Edit 2: Smoove mentioned Rockland earlier in the thread so apologies for the duplication. We really should just have a Smoove Morbidity and Mortality Report stuck to the beginning of the thread that I can check for the latest outbreaks. Suck it CDC! We have Smoove (who may be reading the CDC Morbidity and Mortality weekly reports…)

[Smoove_B]

Edit: So as I dive deeper into this and Smoove can correct or add as needed, patient zero was most likely the person who came down with polio in Rockland County recently. It was genetically tied to a viral variant which arises from people vaccinated with an oral vaccine that has the weakened virus. In rare instances that person can shed the virus. Two things to keep in mind however! One, the US does not use weakened virus in the polio vaccine. So if you have a family member who starts spouting shit about how you can get polio from the vaccine point out this little tidbit (Let’s just say I’m going to a family function where the understanding of science is, um, not so much) Two, this would not be a problem if the surrounding community had a high vaccination rate because the shed virus after tasting freedom would have no one to infect. Unfortunately due to low vaccination rates in the community however…(at this point in the conversation I may get a response about how they have done their research. Due to the lack of alcohol at these functions that will be the signal for me to call for my daughter and say it’s time to go… )

Yes, that's correct. The bigger issue now is the belief that polio is now circulating. People that are vaccinated are protected but those that haven't been aren't, so there's definitely some concern for increased risk.

Vaccination rates were low before COVID-19, but yes, now they're worse. All of this is mind-boggling to me - the syndemic that's currently unfolding.

[$iljanus]

Edit: So as I dive deeper into this and Smoove can correct or add as needed, patient zero was most likely the person who came down with polio in Rockland County recently. It was genetically tied to a viral variant which arises from people vaccinated with an oral vaccine that has the weakened virus. In rare instances that person can shed the virus. Two things to keep in mind however! One, the US does not use weakened virus in the polio vaccine. So if you have a family member who starts spouting shit about how you can get polio from the vaccine point out this little tidbit (Let’s just say I’m going to a family function where the understanding of science is, um, not so much) Two, this would not be a problem if the surrounding community had a high vaccination rate because the shed virus after tasting freedom would have no one to infect. Unfortunately due to low vaccination rates in the community however…(at this point in the conversation I may get a response about how they have done their research. Due to the lack of alcohol at these functions that will be the signal for me to call for my daughter and say it’s time to go… )

Yes, that's correct. The bigger issue now is the belief that polio is now circulating. People that are vaccinated are protected but those that haven't been aren't, so there's definitely some concern for increased risk.

Vaccination rates were low before COVID-19, but yes, now they're worse. All of this is mind-boggling to me - the syndemic that's currently unfolding.

I think the technology that allows for wastewater monitoring for diseases is pretty cool and a game changer for surveillance. Of course if we don’t act on the information in a meaningful way it will just serve as our epitaph after some virus kills the lot of us. Oh well happy Friday!

[Smoove_B]

I think the technology that allows for wastewater monitoring for diseases is pretty cool and a game changer for surveillance. Of course if we don’t act on the information in a meaningful way it will just serve as our epitaph after some virus kills the lot of us. Oh well happy Friday!

It really is. Apparently parts of Europe have been using it for 2+ decades, but here in the U.S. it's still in it's infancy with random cities participating and AFAIK, only very recently because of COVID. NJ still only has 3 sites particiapting (covering ~2 million people), clustered in the NE part of the state. From a population concentration standpoint it makes sense, but there are so many other sources that could be used for data collection to give something other than general sentinel data.

I don't think we've started checking for polio yet, or if we have it's not being shared yet down to my rungs on the public health ladder.

[Kraken]

Tonight we went to a play where the theater required universal masking. They even had mask cops busting scofflaws during the intermissions. It's the first time in a long time that I've seen masks enforced outside of a medical setting.

[Max Peck]

[AWS260]

A Zika update.

When Zika failed to cause much damage in the United States, both the Centers for Disease Control and Prevention, and the National Institute of Allergies and Infectious Diseases, scaled back their funding for work related to the disease. In Brazil, President Jair Bolsonaro, who took office in early 2019, made deep cuts to scientific research.

The few virologists and infectious disease specialists who continued to work on Zika after the epidemic subsided were forced to set it aside when the coronavirus pandemic hit, Dr. Rojas Alvarez said.

***

As research funds have dwindled, Dr. Moreira said, so has the once-robust support for the Zika families.

[Smoove_B]

And so it begins:

A student at an Atlanta-area elementary school has tested positive for the monkeypox virus, according to a Georgia school district.

Newton County Schools officials were alerted Tuesday, Aug. 24, that a student at Mansfield Elementary School tested positive for the virus, according to a news release posted on the district’s website.

A student at Flint Hill Elementary School also is being tested for the virus, officials said.

“NCSS facilities employees will thoroughly clean and disinfect classrooms and other areas at both schools this afternoon to ensure ongoing safe and healthy learning and work environments for students and staff,” according to the release.

Sadly, I doubt it will be the last case. We had our chance to deal with this and we completely and totally failed. Again.

EDIT: It's already up to two kids.

[Jeff V]

Tonight we went to a play where the theater required universal masking. They even had mask cops busting scofflaws during the intermissions. It's the first time in a long time that I've seen masks enforced outside of a medical setting.

This was the case in January when we saw the live production of Frozen. A lady in front of us was given a final warning.

[hitbyambulance]

no surprise here:

https://komonews.com/news/nation-world/ ... -pets-cats

https://rarediseases.info.nih.gov/disea ... oplasmosis

"In the 1970s, scientists estimated that 30% of people were infected with the parasite, but now it is between 30% and 50%, studies say."

given my level of cat obsession, i'd say it infected my brain a while back

[Smoove_B]

Indeed. Toxo has been on the radar for decades. If you want to read a good book, I will still always recommend Parasite Rex.

Spoiler: We are in a never-ending battle against parasites. Some believe we've already lost.

[Victoria Raverna]

Back to COVID, right now Japan is No. 1 in number of new cases and number of new deaths. Looking at that, seem like even a country that the people are still wearing masks after the government relaxed the mask guideline still fails to reduce COVID-19 transmission. What went wrong with Japan's approach?