Did you forget about Ebola?

Ebola Ebola was big news in 2014. But we seem to have lost interest in it, especially now that no one in the US is being treated for the virus. While the number of cases in African countries is dropping, the epidemic and its repercussions are far from over. In fact, there are still important developments happening every day.

A promising new treatment An experimental antiviral drug has shown potential for treating early cases of Ebola. Favipiravir, which has also shown to be effective against influenza, West Nile, and yellow fever as well as other viruses, seems to drastically reduce mortality in patients who are not yet seriously ill. It doesn’t seem to help patients with severe Ebola infection. One of the most important advantages of favipiravir is that it is a pill. Other potential therapies must be kept frozen and are administered through infusion, leaving the health care worker at risk for needle sticks.

Red Cross aid workers suffer from attacks in Guinea In Guinea, public misconceptions about the role of aid workers and the mode of Ebola transmission have led to attacks on Red Cross and other volunteers conducting safe burials of deceased Ebola patients. While many Guineans understand and accept the practices the Red Cross uses to disinfect homes and bury Ebola victims, some are concerned that the Red Cross is actually spreading the virus. This has resulted in an average of 10 attacks per month. The Red Cross is warning that the violence against its volunteers is hampering its ability to contain and quell the epidemic.

Maybe Ebola can be transmitted through aerosols, but probably not One of the best things about this 28 day writing challenge is that through my research I found Carl Zimmer. I aspire to his level of health writing clarity and scientific rigour. His piece “Is It Worth Imagining Airborne Ebola?” does an excellent job of outlining the concerns expressed by a few scientists while also offering the counterpoints that help give those concerns context. Before you get carried away with alarmist headlines, take a look at what he has to say.

From soap and water to soap opera Sierra Leone is starting to move from the traditional forms of public health communication to a more innovative medium. Celebrities are partnering with a major bank to create a soap opera designed to help prevent transmission, explain treatment and safe burial practices, and dispelling myths about Ebola. One of the twelve episodes focuses on quarantine by centering around a family who is under quarantine. Through this storyline, the actors explain what happens during a quarantine and why adherence to it is crucial. In the major city of Freetown, the soap opera is broadcast on television, while in more rural areas, it plays on the radio.

Right now, the Ebola epidemic seems to be waning. However, this epidemic will resonate throughout the region for decades. Even as new public health issues surface, we would be well-served to remember what has and is happening in this part of Africa.

Raw milk, cholera, and Appalachia: Cool stuff I read this week

I came across a bunch of interesting articles and bits of news this week, and I thought I’d share them with you. Spend your lazy Sunday catching up on current events. The Dietary Guidelines Advisory Committee released its recommendations this week. They encourage us to eat less sugar and saturated fat, but say we don’t really need to worry about our cholesterol intake.

There’s a new rapid test for Ebola.

Speaking of Ebola, Al Jazeera America ran a fascinating and discouraging two-part series on the social implications of the epidemic.

Although Haiti has improved its infrastructure in response to the epidemic, cholera is still a major problem in the country.

This interview with the Baltimore City health commissioner Dr. Leana Wen reminds us that public health isn’t just about Ebola and cholera and measles--it’s also about rat control and the social determinants of health. [Audio and abridged transcript.]

Flu season is starting to wind down.

The first broad study of two kinds of muscular dystrophy was published, revealing important epidemiological information about the disorders.

Despite some progress, Appalachia is still teeming with health disparities and poverty.

There’s a new tickborne virus in town.

For goodness’ sake, stop drinking raw milk. Pasteurization exists for a reason!

More than 25% of Americans with diabetes are undiagnosed. That’s 8.1 million diabetics who are not receiving treatment or making lifestyle changes.

Thank you, Alan Cumming, for using humor to highlight just how ridiculous the FDA’s new ruling restricting gay and bisexual men from donating blood unless they have been celibate for a year.

Alan Cumming Celibacy Challenge

 

Come back tomorrow for another Awesome Infographic!

Part III: The terrifying realities of antimicrobial resistance that will keep you up at night

As promised, today’s post will focus on the terrifying realities of antimicrobial resistance. I'm generally not an alarmist, but these two issues are Not Good. We are on our way to a post-antibiotic age of medicine.

The terrifying realities of antimicrobial resistance that will keep you up at night

CRE: Carbapenem resistant enterobacteriaceae This week, I saw headlines about a “nightmare bacteria” that killed two people and infected at least five more. Turns out the nightmare wasn’t such a surprise—the infections were caused by carbapenem-resistant enterobacteriaceae, or CRE.

Enterobacteriaceae are a family of bacteria that includes familiar disease-causing bugs including as Salmonella, E. coli, Enterobacter, and Shigella as well as other bacteria that don’t make us sick. In fact, some of the bacteria found in this family live benignly in the digestive tracts of humans and animals. Others, however, can cause serious illness or death.

What’s particularly frightening is that carbapenems, a particular class of antimicrobials, are usually used as the last-ditch effort to fight infection when other antimicrobials have failed. Bacterial infections treated with carbapenems are nearly always resistant to multiple other drugs. This means that if bacteria are resistant to carbapenems, they’re almost certainly resistant to all other antimicrobials. There are a few drugs that are used to treat CRE, though none of them are particularly effective. If those fail, you're in big trouble.

That’s right: CRE are resistant to basically every antimicrobial. If you get a CRE infection, your chances of survival are 50-50.

CRE are a serious threat to hospital patients. People are unlikely to come across CRE in their daily lives. However, people who are receiving hospital treatment are vulnerable to CRE infections.

I haven’t found any direct evidence linking CRE directly to animal agriculture. However, because carbapenem is only used when all other antimicrobials fail, if the bacteria weren’t already resistant, carbapenem wouldn’t have to be used in the first place! If you’d like to learn more, I recommend starting with Carl Zimmer’s piece “The ‘Nightmare Bacteria:’ An Explainer.”

Foodborne illness is a direct result of animal agriculture When you get food poisoning, it doesn’t matter whether the culprit is ground beef or cantaloupe: the microbes that traveled from your salad to your stomach came from the fecal matter of an animal. Maybe it was the cow you were eating, or one of its neighbors, or maybe it was an animal whose manure runoff contaminated the ground that the cantaloupe grew on. Either way, your gastrointestinal distress is tied directly to the bugs living in the digestive systems of agricultural animals.

CDC estimates that 48 million, or 1 in 6, Americans get a foodborne illness each year. Antimicrobial-resistant infections from food cause 430,000 illnesses each year in the US. Multi-drug resistant Salmonella causes 100,000 illnesses annually. Some strains of illness-causing microbes are becoming less resistant, while others are getting stronger.

A white paper from the Center for Science in the Public Interest shows a bleaker picture. It identifies 55 foodborne illness outbreaks from 1973 to 2011 that were associated with antimicrobial resistant microbes. Foods most likely to be implicated in these outbreaks were dairy, ground beef, and poultry. More than half of the outbreaks were due to multi-drug resistant microbes.

Maybe even more concerning is the fact that 58% of the outbreaks in that 38 year period occurred between 2000 and 2011. That’s right—more than half of foodborne illness outbreaks caused by drug resistant microbes since 1973 have occurred in the 21st century. The number of human illnesses caused by food contaminated by resistant microbes is on the rise.


This series has raised a lot of questions for me, and I plan to continue exploring this issue. Are there any related questions you’d be interested in having me research? I’ll totally do the work for you!


Special thank you to John Phillips for setting me straight on carbapenems. He's going to be a great pharmacist.

TissuGlu, measles, and herbs: Cool stuff I read this week

Source. I came across a bunch of interesting articles and bits of news this week, and I thought I’d share them with you. Spend your lazy Sunday catching up on current events.

  • A father asks a California school district to require unvaccinated children to stay home in hopes that his son, whose leukemia is in remission and who cannot be vaccinated, will not be exposed to measles.
  • The names, addresses, social security numbers, and other personal information for up to 80 million Anthem health insurance customers has been accessed by hackers.
  • Prader-Willi Syndrome, one of the only known genetic causes of obesity, causes significant health problems. This piece in the New York Times Magazine highlights Rachelle, a young woman seeking treatment for the syndrome.
  • The BBC published a series of maps illustrating the growth of the Ebola outbreak within Africa and the presence of Ebola on other continents.
  • It’s about time the Americans with Disabilities Act is applied to websites.
  • The FDA has approved a new internal tissue adhesive called TissuGlu (what a creepy name) for use in surgeries removing excess fat or skin and for repairing separated abdominal muscles.
  • Lots and lots of Chinese kids wear glasses.
  • In store-brand herbal supplements, 4 out of 5 contained fillers like powdered rice and asparagus rather than the herbs named on the packaging.

Read up!

Measles 101

As of January 30, 2015, 91 cases of measles have been reported in California, and 59 of those are linked to the Disneyland measles outbreak. So much for being the place where dreams come true. Hipster Ariel says I wanna be where the people are, better get my MMR

While this current outbreak is upsetting, and another reason for anti-vaxxers to shut up already, measles is a much bigger problem globally than it is in the United States. As with most infectious diseases that aren’t common here, there’s a lot of misunderstanding about what measles is and how dangerous it can be. Here’s a little Measles 101, sourced from WHO, CDC, and reputable scientific journals.

How serious is measles? In 2013, WHO reported 145,700 measles deaths worldwide--that’s about 16 deaths per hour, every day. Prior to 1980, when vaccination became widespread, WHO estimates there were 2.6 million measles deaths per year.

But I thought it wasn’t much worse than chicken pox! Well, there’s a rash and fever. But the complications are what make measles so frightening. Blindness, encephalitis, and pneumonia are a few of the serious complications. Severe measles is more likely among populations who are under age five or over age 20, undernourished (particularly with a vitamin A deficiency), or who have weakened immune systems.

How is measles transmitted? The measles virus can stay alive, airborne or on a surface, for two hours. People who have been infected are contagious for four days prior to the emergence of a rash, and for four days after the rash appears. Historically, each person infected with measles will infect between 11 and 18 other people, though there is some evidence that measles is becoming slightly less contagious in recent years. (This is a really awesome explanation of R0, R, and eliminating infectious diseases. Public health nerds, unite!)

But I thought measles was eliminated from the United States. Technically, as of 2000, it is. All elimination means is that a virus no longer regularly circulates through the population--its theoretical incidence in a geographic area is 0. But that doesn’t mean that measles no longer exists on Earth, so it’s easy for measles to guest star in an outbreak here and there. In 1989-1991, there was a particularly nasty outbreak in the United States in which about 55,000 people were infected, resulting in 11,000 hospitalizations and 123 deaths.

How can I avoid getting measles? Get the MMR vaccine. It doesn’t cause autism, and a 95% of people who get a single dose are immune to measles, mumps, and rubella. A second dose closes the gap, and close to 100% of people who get two doses of the MMR vaccine are protected against all three viruses. Yeah science!

To learn more about measles, check out the Measles and Rubella Initiative. For a more humorous take, The Onion wrote up a great outline of the 2015 outbreak.

If you live in the US and are worried about getting Ebola, you’re self-absorbed.

My dear friend Lisa shared this with me on Facebook: More Americans have been married to Kim Kardashian than have died from Ebola.

 

I love a good Kim K jab, especially if it’s intended to calm down some of this Ebolanoia*. But I quickly realized that while it’s important to properly communicate how unlikely it is for someone in the US to be infected with Ebola, it is equally important not to downplay the seriousness of what’s happening in West Africa.

 

At this point, we’ve all talked with a person who’s terrified of contracting Ebola. Or maybe we’re that person ourselves. But honestly, the likelihood of someone in the US coming down with it is miniscule. There have been three confirmed cases and a total of 172 people are under surveillance due to their contact with the three cases. Sixty of those people have completed surveillance and are healthy. Ebola’s R0, the number of people one person with a disease is likely to infect unless precautions are taken, is between 1.5 and 2.

 

And precautions are being taken. We have been quarantining anyone who’s come into contact with the Ebola patients in the US. Ebola is only contagious once a person starts showing symptoms, so if someone in quarantine—the only people who had direct contact with the confirmed cases—shows symptoms, the newly-sick person will not be able to infect anyone else. This means that Ebola will almost certainly not be a problem in the US.

 

However, Ebola is a huge problem in West Africa. In the countries of Guinea, Liberia, and Sierra Leone, more than 9000 people have contracted the disease, and half of them have died. People living in these countries are the ones who are at risk, not those of us sitting comfortably on our couches reading (and/or writing) blog posts about Ebola.

 

So, those of us in the US shouldn’t be worried about catching Ebola. But that doesn’t mean we shouldn’t be worried. We just need to be worried about the right thing.

 

Although it’s killing West Africans almost exclusively, Ebola is a world-wide health concern. Not just in a don’t-want-to-spread-the-disease kind of way, but because every life matters. Each person infected with Ebola has a basic human right—the right to health—taken from them. This is an avoidable travesty. We know how to stop the epidemic, and yet we are not. The lives of the people of Guinea, Liberia, Sierra Leone, and other West African nations are meaningful.

 

If you’re one of the people who are convinced they’ll get Ebola sitting in a movie theater in New Jersey or on a plane to Kansas City, I urge you to channel that anxiety into something more constructive. Donations to organizations doing good work will likely be the best way to help. CNN has a good list. If financial support isn’t an option for you, become an educated megaphone for sane Ebola information. Learn what’s really going on and post about it on Facebook, talk to your coworkers, email your mom.

 

And if you make any more Kardashian+Ebola memes, send them my way.

 

 

*a portmanteau of Ebola and paranoia. I discovered and fell in love with this term via Maryn McKenna.

Friday Five: Hajj, pinkwashing, listeria, IVF, President Taft

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Hajj ends with no significant health scares

The Muslim pilgrimage to Mecca, called hajj, concludes today. Public health officials worried about the spread of MERS as well as the annual concerns of fires, stampedes, and the transmission of pathogens through the ritual of head shaving. Thankfully, there have been no injuries or deaths so far (though we’ll have to keep watch for MERS and the infectious diseases associated with the head shaving). The number of pilgrims was down significantly from 3.2 million last year to just under two million this year. Hopefully, this success can be emulated in future years—keeping people safe during religious rituals should be a priority for Saudi Arabia.

 

Just say no to pinkwashing

I don’t understand how someone thinks that purchasing pink M&Ms or water bottles or scarves does any more good than donating directly to a breast cancer research charity—and in fact, it doesn’t. Luckily, Breast Cancer Action runs a campaign every October called Think Before You Pink, encouraging consumers not to purchase these products. This year they’re targeting the known carcinogens that are in various “awareness” items. They’re pushing for legislation that would require chemicals in consumer products to be tested for safety before they come to market, something that is not required now. Take a look at what they’re proposing, and even if you don’t want to sign the petition, please consider sending a couple bucks to the American Cancer Society or another reputable charity rather than buying a pink iPhone case

 

Food recall: listeria edition

There is yet another food recall this week, this time with ready to eat chicken and ham products from Garden Fresh Foods tainted with listeria (the irony of company names involved in recalls always makes me giggle). Garden Fresh had a previous recall in September involving foods sold at Target, Weis, and other outlets. If you bought chicken or ham salad from Weis, and the package has "EST. 17256" or "Est. P-17256" printed on it, throw it away! Listeria usually causes trouble in the usual vulnerable groups: elderly adults, pregnant women, small children, and people with compromised immune systems. For the list of recalled foods, see the USDA.

 

IVF has been a huge success

Preliminary research shows that there have been at least five million births as a result of in vitro fertilization (IVF). IVF is the process of stimulating ovulation, retrieving eggs, fertilizing those eggs in a controlled environment, and transferring the resulting embryo into the woman’s uterus. People choose to use IVF for many reasons: maternal age, fallopian tube issues, male infertility, or to allow LGBT couples to have a child biologically related to a partner. Infertility is losing its stigma in no small part due to the surge in IVF babies. Having options about when and how to start a family is crucial, and being able to talk about those options and decisions helps normalize the ideas for others.

 

Former presidents…they’re just like us!

William Howard Taft, our portliest president, seems to have used the late 1800s version of Weight Watchers to slim down. New research shows that he had a years-long correspondence with a weight loss doctor who suggested a low-fat, low-calorie diet combined with exercise, portion control, and daily weigh-ins. Taft lost weight, but complained of constant hunger—no surprise because he was limited to small portions of meat, vegetables without butter, plain salad, and cooked fruit. He was not able to stick to the diet long term, so he eventually regained the weight he lost, much like modern dieters. Permanent weight loss is incredibly difficult, and Taft shows us that even the powerful can struggle with their weight.

 

Oh, and I’d love if you’d check out the first episode of my new podcast, Action Phase!

Friday Five: Salmonella, abortion, bubonic plague, rabies, Tom Hanks

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week.  

Government shutdown, Foster Farms, and drug-resistant Salmonella

Foster Farms—a chicken processor who was the source of a Salmonella outbreak earlier this year—has been implicated in selling meat that has sickened at least 278 people in 17 states. Although the processor insists the problem is due to consumers insufficiently cooking their chicken, they have decided to revamp their procedures rather than be shut down by the USDA. This particular outbreak consists of seven strains of Salmonella, four of which are drug resistant—and due to the government shutdown, the CDC cannot properly investigate the problem and may be missing information that could reduce illness or save lives. This is a perfect example of a useful government program that should be funded regardless of politics…salmonella doesn’t care if you vote red or blue.

 

Abortion news

There’s lots going on this week regarding abortion. A woman who will have to leave the country to terminate her pregnancy since she is carrying twins who have anencephaly is highlighting Northern Ireland’s total ban on abortion. Ohio passed a budget that included three abortion restrictions, and the ACLU is suing the state, claiming the rules have nothing to do with the budget and are unconstitutional. The Nebraska Supreme Court upheld a ruling stating a pregnant foster child was not mature enough to elect to have an abortion, so she must deliver the baby and place it for adoption. Arsonists have tried to attach the Planned Parenthood in Joplin, Missouri twice in one week. Finally, some good news: California expanded access for abortions by allowing nurse practitioners, physician’s assistants, and certified nurse-midwives to perform abortions.

 

Bubonic plague may be an issue for Madagascar

Unless Madagascar gets its rat population under control, it’s likely to face a bubonic plague epidemic starting this month. That’s right, the Black Death is endemic in the island nation. Rats abound in the main prison, and the concern is that if the bacteria is introduced to those rats, the fleas they carry will be able to spread bubonic plague to inmates, employees, and visitors. And you can’t just kill rats—you have to kill the fleas, too. No word on what’s being done to avert this potential disaster.

 

Rabies vaccines are way too pricey

Fewer than 10 people have been documented as surviving full-blown rabies, but if a person who has been bitten receives the rabies vaccine before serious symptoms develop, they are likely to survive. Rabies kills about 24,000 people, mostly children, annually across Africa (approximately 26,000 die in Asia). Rabies experts at a conference this week in Dakar, Senegal suggested the best preventive measure is to tie up dogs since the post-bite treatment is cost prohibitive to most people who are bitten in Africa. The treatment requires four or five injections that cost about $13 each. Seems to me that rabies vaccine manufacturers Sanofi Pasteur and Novartis should be striking a deal with someone to lower these costs and save a huge number of lives.

 

Tom Hanks has Type 2 diabetes

During an interview with Dave Letterman, America’s favorite actor Tom Hanks announced he has Type 2 diabetes due to years of uncontrolled high blood sugar. Hanks doesn’t blame his weight fluctuations for movie roles, but says, “I think it goes back to the lifestyle I’ve been leading since I was probably seven, not 36.”  He joins the ranks of Paula Deen, Randy Jackson, Billie Jean King, Patti LaBelle, Larry King, and 25.8 million Americans. Can you imagine if Paula Deen, Larry King, and Tom Hanks did a diabetes prevention campaign? That’d be TV ratings gold.

http://www.youtube.com/watch?v=wBhZoTN2bvM