Browsing Tag

Epidemiology

Is Monsanto Behind Cases of Microcephaly in Brazil?

By February 17, 2016 12 Comments
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I am a medical doctor and professor of public health, and I am also the father of a beautiful daughter and uncle to the world’s best niece.  We also live in Rio de Janeiro, Brazil.  We are being inundated with information and misinformation about Zika and its correlation to microcephaly.  There is a lot of fear, which is the perfect environment for people to spread false information.

When I saw friends sharing an article based on fear and not facts, I knew I had to comment due to my background.  If you have not seen this article, you can read it here, but it claims the reported increase in microcephaly in Brazil is caused not by Zika or any other virus, but a larvicide called Pyriproxyfen.  Larvicides are used to kill mosquito larvae and since Zika is spread by mosquitoes this bit of misinformation could cost lives.

The article references a mysterious document purportedly written by “Argentine doctors.” The organization that undersigns it is the “Red Universitária de Ambiente Y Salud”, which is a loose affiliation of individuals dedicated to fighting the use of pesticides, agrotoxics and the like. Perhaps the biggest clue that the information in the document is not trustworthy is that the name of larvicide called into question is repeatedly spelled wrong throughout.

I will address the claims made in the executive summary of the document point by point.

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Categories: Ages + Stages, Chronic Illnesses + Conditions, Disability + Disability Advocacy, Infectious Disease + Vaccines, Newborns + Infants, Science 101 + Mythbusting

Planning A Pregnancy in the Time of Zika

By February 9, 2016 1 Comment
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Like a lot of couples, my wife and I have waited to start a family until the time was right for us, which just so happens to be now-ish.  Unfortunately the right time for us has coincided with the spread of the Zika virus in North America, a virus that shows an association between infection with it during pregnancy and an increased risk of microcephaly (reduced brain/head size) in newborns. The Zika virus is not a new virus from a historical perspective, however, the newly accepted correlation with microcephaly seems to have given the virus a significant amount of media attention.

For any expectant parent – or couples planning on getting pregnant, like my wife and me  – the possibility of a Zika infection is terrifying.  My wife and I are the kind of people who like to arm ourselves with information, so let’s dive into Zika virus infections and take a look at some facts and figures.

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Categories: Infectious Disease + Vaccines, Pregnancy, Birth + Family Planning

What is Microcephaly + What’s the Link to Zika?

By February 1, 2016 1 Comment
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With the increasing news coverage of Zika and it’s reported link to the birth defect microcephaly we’ve received a number of reader questions about microcephaly and what it actually means for children born with the condition.  We reached out to infectious disease specialist, Dr. Judy Stone, to answer some of your questions.

What does microcephaly actually mean (Is the brain small, does it stop growing at a certain stage, is part of the brain missing)?
Microcephaly literally means an abnormally small head. Both the skull and brain are abnormally small with microcephaly, and X-ray studies often show abnormal calcified areas in the brain and lack of normal development.

Is Zika the only way a baby can be born with microcephaly or are there other risk factors?
Microcephaly has been associated with many infections as well as genetic abnormalities, malnutrition, or exposure to certain toxins. It already happens very rarely in the U.S. due to the level of nutrition and prenatal care most women receive (although even with good nutrition and proper prenatal care, microcephaly can still occur due to certain genetic factors or infections). Even in Brazil, the “epidemic” of this birth defect is thought to be <1%. Some researchers think that some of the sudden apparent increase reflects changes in reporting rather than new illnesses. It’s also important to know that the link right now is just correlated with Zika, there hasn’t yet been a cause and effect relationship proven, but it’s enough to raise alarm bells.

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Categories: Ages + Stages, Chronic Illnesses + Conditions, Disability + Disability Advocacy, Infectious Disease + Vaccines, Newborns + Infants

Zika and Pregnancy: What You Need to Know

By January 19, 2016 2 Comments
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The Zika virus has been in the news a lot lately because it’s been linked to a cluster of cases of microcephaly in Brazil and Columbia. Microcephaly is a rare birth defect where the fetus’ brain does not develop fully in utero, and as a result, the baby is born with an abnormally small head and multiple neurological disorders.

Public health officials have been aware of Zika for decades, however, it was only believed to only cause mild flu-like symptoms with few, if any, lasting negative outcomes. The virus is spread by mosquitoes and recently cases as far north as Mexico, Hawaii and Puerto Rico have concerned public health officials in North America.

On January 15, the Centers for Disease Control and Prevention (CDC) issued a level-two travel alert for Latin America and the Caribbean, with a special note for pregnant women to avoid those areas. Since then we’ve been asked about Zika by a number of readers. We reached out to Dr. Waleed Al-Salem, a tropical medicine specialist and father based in Liverpool, England, to have him answer your questions.

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Categories: Ages + Stages, Chronic Illnesses + Conditions, Disability + Disability Advocacy, Infectious Disease + Vaccines, Newborns + Infants

How to Protect Your Family from Viral Meningitis

By October 12, 2015 1 Comment
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There are certain diseases that instantly cause dread and fear when spoken about, especially when it comes to our kids. The mere mention of polio, measles, and meningitis create panic and fear within a community and I should know – I’m the father of an infant and every time we’re told one of these diseases is in circulation, my anxiety level goes up. Most recently, an unusual increase of viral meningitis has been observed in the western part of Michigan, and also in southern Maine. This has health officials very concerned yet determined to inform the public about its increased community presence.

But what is viral meningitis exactly, and how can you protect yourself and your family from this illness?

First, we need to understand what part of the body meningitis affects. The meninges (meh-nen-gees) are the protective layer of tissue that cover your brain and spinal cord. Based on the organs that your meninges protect, you can tell that they perform a very important job. Along with the meninges, a fluid bathes your brain and spinal cord to provide nutrients (called cerebrospinal fluid, or CSF for short). However, it is this CSF fluid that, when infected, leads to meningitis. Your meninges also rely on other tissues to support and enhance its ability to protect your nerves and brain. For example, certain cells in the nervous system produce and secrete fluid that provides nutrients to the brain and spinal cord.

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Categories: Ages + Stages, Infectious Disease + Vaccines, Newborns + Infants, School-Aged Children, Toddlers + Preschoolers, Tweens + Teens

What “Fear the Walking Dead” Gets Right About Public Health

By August 24, 2015 No Comments
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When I was 16 weeks pregnant with my son I caught a nasty head cold. Unable to take any of the traditional over the counter cold medications (because, pregnancy), I was forced to ride it out in misery on the couch praying for my own swift demise. The cold knocked me down hard and by the second or third day of misery on the couch I had binged watched just about everything I could binge watch.

Then I came across The Walking Dead on Netflix. Now, I had very particularly avoided watching the show because my fellow #publichealthnerd colleagues had pressured me to watch it, and urging me to do something is the best way to get me to not do that thing. I’d also avoided watching it because I’m not a fan of horror.  Blood and guts are not my preferred form of entertainment. Sure, give me intrigue, drama, suspense and I will eat it up (hello House of Cards and Mad Men) but toss in zombies or vampires? I’m out.

But it was a few days before Hallowe’en* and I was 16 weeks pregnant, miserable, and out of binge-worthy TV. I decided to give the first episode a watch…and I haven’t looked back since. Well, except during the really gory scenes. Where I literally look backwards.

As a public health nerd, I can say that there have been times where from a public health standpoint the show has been laughable. The season one finale where our group of survivors winds up at the CDC?(OH COME ON!) Nothing that the show depicted about the CDC’s facilities in Atlanta is even remotely accurate. Even the evidence the CDC researcher claims to have (as in, shooting someone while in an MRI machine? OH COME ON!!) was preposterous.

Don’t even get me started on the idea that the CDC somehow, somewhere, has billions of dollars squirreled away for a state-of-the-art underground command center. Please show me the line item for that in the annual congressional allocation. I’m sure if Congress did earmark funds for a Dr. Evil-like underground lair, there would be a deafening outcry from both within and without the CDC for the desperate need for that funding to go towards more pressing public health concerns. Like anything not secret-underground-lair-ish.

I digress.

When the announcement came early this year that there would be a spin-off show of The Walking Dead, detailing the beginnings of the zombie apocalypse, I was intrigued, if not concerned. After the complete media fail that was the news coverage for Ebola in America I was suspicious about how the show would portray public health infrastructure, and to be frank after the premiere I still am, but the premiere gave me much to be hopeful about.

*** WARNING, VERY MILD SPOILERS BELOW ***

The family at the center of Fear the Walking Dead c/o AMC.com

The family at the center of Fear the Walking Dead c/o AMC.com

The premiere episode does do a great job of highlighting the world as it currently is. We have made accommodations, and in fact are comfortable with, symbols of fear in our daily lives against things like violence (metal detectors in high schools, bars on the windows of homes, police activity). Likewise, we’re somewhat oblivious to more insidious threats like drug abuse and infectious disease.

What the show does get right in terms of science in its first episode is the emergence of the Walking Dead’s infamous zombie virus in an intravenous drug using population. A variety of infectious diseases have presented first or early among members of this group, including HIV/AIDS and numerous bacterial infections.

The reason for this is simply because of the behaviors associated with the practice; needles are often shared, and blood and other bodily fluids are exchanged,making it the perfect scenario for bacteria and viruses to replicate and mutate.

The demographics of IV drug users also interferes with what public health nerds call epidemiological surveillance. Epidemiological surveillance is how public health officials monitor what viruses, infections, and diseases are prevalent in a given population. The most common form of this surveillance is through passive surveillance, which is when an individual reports to their health care provider with an illness or concern and its documented, instead of public health officials actively seeking out cases.

If this sounds a little creepy, it’s actually not. Typically, and depending on the disease, your doctor or hospital isn’t reporting to the CDC that you, Jane Doe, born on this date, had the flu. What they’re reporting are generalities, so that public health officials can assess where resources would be best allocated. What your doctor or hospital reports is that a female, in this age range had this strain of flu at this time.

But the fatal flaw in passive surveillance is that it requires people to actually go to their health care provider. Unfortunately IV drug users tend to lack the means to seek out timely medical care. In many cases, a lack of a regular income, health insurance, fear of being reported to the police, or simply fear of judgment means that people often wait until an illness has reached a crisis point before they seek medical care. This means that illnesses can circulate undetected in the population for a longer period of time than they would in a population without similar barriers to accessing health care.

When looking for their son, whom they fear has fled hospital to score heroin, the main characters of Fear The Walking Dead drive through several rough neighborhoods where “Missing” posters have gone up on walls and fences. The implication the audience is meant to intone from these posters is that there is a massive outbreak underway that the powers-that-be are not yet aware of, because of who the missing (we know to be zombified) individuals are.

The genesis of the zombie virus in an intravenous drug using population was something I wasn’t expecting from the show, but something I find completely plausible (as plausible as a zombie virus can be).  I was concerned considering the show’s previous ridiculous portrayal of the federal public health infrastructure, that the writers would go in the direction of a government-engineered virus released on an innocent and unsuspecting public.  If they’d done that, I would have been out immediately and I have to admit, it probably would have ruined the original Walking Dead series for me as well.

I have to say, Fear the Walking Dead has stepped up its game in terms of scientific accuracy, which I greatly applaud.  But I’m obviously not watching it for that – or maybe just partially. As my husband can tell you, I’ve spent a good chunk of time watching The Walking Dead yelling at Rick and his crew “FOR THE LOVE OF GOD, HOW HAS NO ONE DIED OF A STAPH INFECTION YET?!”  Robert Kirkman, if you’re listening, someone on the show needs to step on a rusty nail and die of tetanus.

*I’m Canadian, so I spell Hallowe’en with an apostrophe

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Categories: Policy, Politics, + Pop Health

How Did E. coli Wind Up in Bottled Water? Spoiler Alert: Poop

By July 14, 2015 No Comments
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Just as summer started in late June, officials from Niagara, LLC initiated a large recall of their bottled water due to evidence of E. coli at the company’s spring water source. This was cause for concern for many people, including parents, as summer is when bottled water is a regular go-to and most in demand, and of course because E. coli has earned a (rightfully) bad reputation.

It may make your skin crawl to think about it, but on and in just about every living thing, there’s a whole host of naturally occurring microbes. This includes humans. That’s right, naturally occurring microbes have taken up residence in your skin and gut and you need them to live.

Eschericia coli or more simply E. coli is a naturally occurring and very important microbial resident in the digestive tracts of cattle, ruminants (sheep, goats and deer), mammals and birds. People often think that E. coli is a single type of bacteria, but in fact it’s a large and diverse group of microbes.

In animals, E. coli is classified as a commensal microbe, which means that the bacteria lives within these animals without causing disease and helps the animal’s digestive tract extract important nutrients from food. These bacteria, like the ones that live in our guts, eventually they die and are shed when the animal defecates (see: poops).

So, if E. coli is a naturally occurring bacteria why is it a problem when it gets into the human food supply?

In 1982, a new subtype of E. coli was discovered in cattle that were very distinct from the standard E.coli shed by animals for the benefit of their health. This new subtype named 0157:H7 still lived in the animal’s gut and was shed through the same method (see: poop). In 1993 the new subtype was identified as the cause of a large outbreak of an illness that caused hemorrhagic diarrhea, kidney failure and even death. The common thread among all of the victims were that they’d consumed undercooked beef from a large fast food restaurant.

So if E. coli 0157:H7 lives in the guts of animals, how did it get into hamburger meat in 1993 and how did it get into the Niagara, LLC bottled water supply?

In 1993 the outbreak was traced to meat processing plants that lacked protocols to ensure that bacteria from the animal’s gut didn’t contaminate the meat used for human consumption. In terms of the issue with Niagara, LLC it comes down to how we handle poop: our own and that of animals.

Humans have built intricate sewage systems that handle our waste en mass, but the same cannot be said for animals such as cattle. During periods of heavy precipitation or snowfalls, E. coli can potentially be washed into bodies of water used for swimming and drinking. Another potential source for E. coli are from raising cattle. Human farming practices such as irrigation can carry animal waste from fields into close contact with crops and potentially into bodies of water used by humans.

E. coli infections with the serotype 0157:H7 are the most common cause of disease via the production of a shiga toxin. The toxin and the resulting disease can infect almost anyone but the very young and the elderly are most at risk. The primary symptoms are abdominal cramps, vomiting and bloody diarrhea. These populations can develop hemolytic uremic syndrome (HUS), which can lead to kidney failure and death.

Niagara LLC acted very responsibly after learning that the potential for infection was present and began the recall. Their products reach a very wide customer base in multiple states through a number of retail outlets. Prevention is typically the best method of reducing chances of infection and these preventative methods are usually very simple.

  1. Wash your hands after going to the bathroom, prior to and after preparing food and after changing diapers.
  2. Avoid swallowing water when swimming in lakes, rivers and kiddie pools.
  3. Properly handle and cook meats.
  4. Do not consume raw milk or unpasteurized juices.
  5. If you suspect that you or your child is sick, consult with your health care provider immediately.

These outbreaks do not occur as often but when they do, the effects have a major impact on the population at large. As consumers, we have to be very prudent in the choices we make and using the prevention methods at hand to keep our families safe. – Edited by Leslie Waghorn

 

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Categories: Food, Nutrition, + Infant Feeding, Infectious Disease + Vaccines

The Water-borne Vibrio vulnificus Bacteria: What Are the Risks?

By June 24, 2015 3 Comments
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It’s already been a difficult year for beach goers on the east coast, as if shark bites on two different beaches in North Carolina weren’t bad enough now the most recent scare: what the media is calling a”flesh-eating bacteria” in Florida.  A recent report noted that 7 Floridians have been infected with the Vibrio vulnificus organism so far in 2015, and three of them have died.

Understandably, when terms like “flesh-eating bacteria” are thrown around as it has been in the case of V. vulnificus, fear follows.  That’s one reason health departments don’t like that term—and it’s not scientific, in any case, as the clinical term is “necrotizing fasciitis.” Various news outlets have reported deaths and serious infections this year associated with “flesh eating bacteria,” but these are not all due to Vibrio vulnificus. In this news story, the cause of infection is actually a completely different organism called Streptococcus pyogenes, but they inexplicably discuss Vibrio vulnificus throughout the body of the story, clearly not the same thing. So, let’s sort out just what V. vulnificus does, and how concerned a parent should be.

What is Vibrio vulnificus?

Vibrio vulnificus is part of a group of bacteria that typically cause gastrointestinal illnesses, including vomiting and diarrhea. The best known of the Vibrio family is probably the organism that causes cholera, a water-borne disease that is frequently life threatening. While Vibrio cholerae causes somewhere on the order of 2-4 million cases of illness and up to 140,000 deaths worldwide per year, it is rare in the United States; most cases of cholera diagnosed here are due to international travel. More common are other members of the Vibrio bacteria family. Vibrio parahaemolyticus is the most common Vibrio infection in the United States, and like its cousin V. cholerae, it causes gastroenteritis (though it’s typically much more mild than cholera). Most cases of V. parahaemolyticus infections come from eating seafood, such as oysters, clams, and mussels—especially when they are eaten raw. V. vulnificus can also cause gastroenteritis, but it’s not very well-described. Like V. parahaemolyticus, most cases of V. vulnificus gastrointestinal disease have been linked to seafood, and especially oysters and shrimp.

More commonly, V. vulnificus causes skin and soft tissue infections or “SSTIs.” These can range from a mild skin infection to a very invasive disease, including necrotizing fasciitis (the misrepresented “flesh eating” component), where the fascia—the tissues that line and separate the muscles—are attacked by bacterial infection. As the bacteria spread and these tissues die, infections like these can require amputation of the infected limb or removal of diseased tissue—that’s where many of the most gruesome reports of these infections come from. It’s also worrisome because symptoms can progress very quickly. Symptoms can present in less than 12 hours from exposure to the bacterium, and death can occur within 24-48 hours. In the worst case, these infections can lead to bacteria in the blood (sepsis), and death.

Where is it found?

Courtesy: CDC/James Gathany (PHIL #7815) via the CDC Public Health Image Library

Courtesy: CDC/James Gathany (PHIL #7815) via the CDC Public Health Image Library

V. vulnificus is most commonly found associated with waters of the Gulf of Mexico and the Atlantic seaboard, though it can be found in other areas as well. It can be associated with natural disasters – an increase in V. vulnificus infections was detected following Hurricane Katrina and the hurricane’s associated floodwaters. The bacterium flourishes in brackish waters, where fresh and saltwater merge, and is thought to be increasing in abundance due to decreases in ocean salinity associated with climate change. It also is more common in the summer months, due to rising water temperatures that encourage bacterial growth. Most cases occur between May and October. In Florida, V. vulnificus is the most common Vibrio illness, associated with wound infections primarily, and oyster consumption secondarily.

How common is it?

Luckily, not very. One report documented only 944 cases of V. vulnificus infections reported in the United States between 2001 and 2009. States in the Gulf Coast region average about 50 cases, 45 hospitalizations and 16 deaths annually, according to the Florida Department of Health. It should be noted that this is probably a low estimate, as many individuals with mild infections may not go to a physician for diagnosis and treatment. Of those who do become ill with V. vulnificus, many of them have other health conditions that make them more vulnerable, in particular, people with diabetes, liver disease, alcoholism, or cancer are particularly susceptible.

How can it be avoided?

For the vast majority of people, coming into contact with V. vulnificus will not result in any harm. Those who are at risk include individuals with pre-existing conditions as noted above, and individuals with open wounds. Carefully covering wounds, or better yet, staying out of the water if an open wound is present, can reduce the chance of acquiring a serious V. vulnificus infection. Avoiding brackish waters can also lower one’s risk. If you experience a cut or scrape while swimming, clean the wound carefully and seek medical attention immediately if it becomes swollen, red, and/or hot to the touch. Wear shoes or some kind of foot protection in rocky areas, to avoid cuts that can introduce V. vulnificus. Cooking seafood rather than eating it raw will also lessen exposure to the bacterium.

While V. vulnificus can be scary, the risk to healthy individuals is quite low, particularly if simple precautions are followed. Have a good time at the beach, and with simple precautions, you should likely be more concerned about sunburn than a “flesh-eating disease!”

 


 

Resources:

Brian Clark Howard. What You Should Know About Shark Attacks After Recent Bites. National Geographic. Accessed 6/23/15

Officials: Don’t call it ‘flesh eating bacteria’. Wstp.com – Channel 10 News. Accessed 6/23/15

Philip Ross, Flesh-Eating Bacteria From The Ocean? Necrotizing Fasciitis Coming To US Beaches This Summer. International Business Times. Accessed 6/23/15.

Janda JM, Newton AE, Bopp CA. Vibriosis. CLin Lab Med 35:273-288. 2015. Accessed 6/23/15.

Scott Gold, Newest Peril From Flooding Is Disease. Los Angeles Times, September 6, 2005. Accessed 6/23/15.

Weis KE, Hammond RM, Hutchinson R, Blackmore CG. Vibrio illness in Florida, 1998-2007. Epidemiol Infect 139:591-8. 2011. Accessed 6/23/15.

 

 

 

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Categories: Infectious Disease + Vaccines