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Global Health

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

Americans, Public Health Rules are Different in Other Countries. Adjust!

By June 30, 2015 1 Comment
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American families traveling outside of the country this summer for a vacation, heads up, you might want to see your doctor before your trip. Whether you’re driving an hour to Canada or Mexico or flying across an ocean, there are two key things you want to consider, even if you’ve done your particular journey many times before:

  1. What vaccinations are recommended for the areas that you’re traveling to?
  2. What extra medications might you need to bring with you in the event that you or your children do get sick, and can’t quickly access familiar healthcare options (pharmacies, drugstores, physicians)?

I’m going to focus on travelers’ vaccines in this post, because it’s not the first thing that parents typically think about when going abroad.  To be clear there’s no law or mandate requiring you to get certain vaccines in order to travel abroad, in fact it’s just the opposite.  The State Department and CDC make recommendations, but it’s up to each individual and each parent to make those decisions for themselves based on the risk they perceive.

We all judge risk differently, and depending on the disease, the risk of contracting it may seem small enough to skip the recommended vaccines. But many of the worst infectious diseases you’d contract both here and abroad are actively avoidable, and the so-called “best case” scenarios of catching and recovering from those diseases with little impact are rare, exceptional, and statistically unlikely. After all, deadly infectious diseases, as they’re named, can kill you. They can permanently harm you. And they can leave you and your kids incredibly ill, suffering, and in quarantine, much like the recent case of the 6-year-old boy in Spain whose parents refused to vaccinate for diphtheria. After being in treatment for weeks with that deadly illness, that boy recently died.

Staying unvaccinated in the face of risk is a gamble with what is most precious – our lives.  I don’t feel comfortable taking that gamble because I’ve seen the statistics and science, and they’re stacked against any other decision. This issue came up recently as my soon-to-be stepsons are heading off to Mexico on vacation in a few weeks, a place that they frequent with their other half of the family since it’s literally an hour south of our collective homes in San Diego, California.

My fiance ran across the CDC traveler’s vaccine recommendations for Mexico via the State Department’s website as he was renewing his Passport two weeks ago, and found a recommendation for travelers to get both the Typhoid Fever and Hepatitis A vaccines for trips to Mexico, in addition the standard vaccines that most of us already have. When he spoke to the boys’ pediatrician about it, the physician seconded that recommendation. Though they hadn’t had the shots before, to be fair, travel to Mexico isn’t really a huge deal here. It’s a pretty acceptable and normalized option for many people for their day trips, family visits, and cross-border commutes to work. But during an informal poll of mine, I found that there seems to be a misconception that going to Mexico is really not like visiting a typical “foreign country,” and there are no needed travelers’ vaccines. That’s actually incorrect.

The oral Typhoid Fever vaccine - taken as 4 pills over 1 week

The oral Typhoid Fever vaccine – taken as 4 pills over 1 week

Despite its familiarity and its proximity, Mexico resides outside of the bounds of the U.S. public health bubble. That means that nation’s population doesn’t have the same vaccination requirements, statistical herd immunity, or public health rules and regulations for food handling, hospitals, etc. Many locals here might be surprised to learn that despite its proximity to San Diego, Mexico is actually considered a “developing” country, which is a fancy-shmancy term that captures a wide range of development, economic, and human factors. The designation also means that you as a traveler need to be cognizant of where corners may be cut in public funding (specifically for the purposes of this post, healthcare, and cheap/free vaccination availability), and take the appropriate precautions to safeguard your health. For my fiance, that meant he realized the boys needed to get their Typhoid vaccinations ASAP if they hadn’t already.

One of the many things the boys are excited about for this trip is that they’re staying at a resort location; but it’s also a reason given for why they might not need these vaccines, after all, it’s in a well-developed part of the country.  But just because they’re staying at a high-end resort, doesn’t mean they’re any safer from these diseases. I’m here to tell you that you don’t need to roll around in garbage and poop (yes, I said poop) in the jungle with no doctors for miles to get sick from something abroad. Sometimes it’s as easy as touching our faces after touching something contaminated that we were completely unaware of. Otherwise, we wouldn’t be taught to wash our hands the way that we do after we go to the restroom – after all, germs are invisible.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Typhoid Fever is definitely something along those lines, something that spreads largely through poor hygiene practices, since it comes from Salmonella Typhi, a bacteria that only lives in humans’ bloodstreams and intestinal tract, and gets transmitted easily, typically through contaminated food or drink (contaminated by, you guessed it, fecal matter). It’s not common in the U.S. with an estimated 6,000 cases per year, with 75% of those coming from international travelers. In developing countries, it affects a staggering 21. 5 million people a year – and it killed an estimated 161,000 people worldwide in 2013. Per the reports (and the one man I know who has had it, and got it from a 5-star resort abroad!), it takes 1-2 weeks to fully show up in an infected individual, it lasts around a month with treatment, and it’s awful: high fevers of up to 104 degrees Fahrenheit, a rash, exhaustion, delirium, swollen organs, and in worst case scenarios, internal bleeding and death.

So this was an issue easily remedied. Fortunately, these days, 4 simple pills taken over the course of a week can prevent all of that. A small copay, a series of pills, and the boys are now ready to go, teenage hygiene and poop threats be darned! Even better, they’ll be protected against the majority of cases for the next 5 years.

As Americans (and I’m talking generalities, of course), we tend to have an oblivious attitude toward how different things can be in other cultures and countries. And things are not always what we assume they are (read: the same as we are accustomed to), no matter how similar they may look. When confronted with this reality, we can fight it, avoid it, or we can just get over it, already, and adjust our behaviors in a way that best serves us and our children. So, adjust, protect, and avoid the awful things you can. There’s plenty of time to catch Monteczuma’s revenge in the meantime, if you really want to get sick while you’re abroad. Just remember to get a prescription of traveler’s antibiotics and some Pepto before you go.


Resources:

Centers For Disease Control Travel Center Accessed: 06/29/15

 US Passports and International Travel Country Information State Department. Accessed:  06/29/15

 Boy Dies Diphtheria Spain, Parents Rejected Vaccine ABC News/AP News. 06/27/15. Accessed: 06/29/15

 Country and Lending Groups .World Bank Data. Accessed: 06/29/15

 Community Immunity. Vaccines.gov. Accessed: 06/29/15

Germs. Communicable Disease Control and Prevention. San Francisco Department of Public Health  Accessed: 06/29/15

Typhoid Fever National Center for Emerging and Zoonotic Infectious Diseases. CDC.Gov. Accessed: 06/29/15

GBD 2013 Mortality and Causes of Death Collaborators. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), 117–171. doi:10.1016/S0140-6736(14)61682-2

The New York Times Health Guide: Typhoid Fever. Accessed: 06/29/15

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

The Deadly Toxin You May Not Have Heard About

By June 10, 2015 1 Comment
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In Spain a little boy is being kept alive by machines and eight other children have been hospitalized after being infected with a deadly toxin. This toxin can cause the nose of an infected individual to drip blood and pus-filled infection, the roof of their mouth to bleed and turn green and black, can obstruct their airways, and can cause patches of skin to become scaly and leather-like.

The toxin invades the body’s mucus membranes, enters the blood stream, and multiplies rapidly. Most alarming is that the first symptoms this toxin in the body are similar to that of a cold, until the inside of the victim’s mouth turns gray and scaly, by which point the toxin has likely already entered the bloodstream and attacked the other mucus membranes in the body, and the patient has likely already infected other people.

Twenty percent of infected patients under the age of five will die and 5-10% of patients over the age of five will die. That mortality rate has remained unchanged for 50 years, despite medical advances.

This toxin is caused by a naturally occurring bacteria of the same name called Corynebacterium diphtheriae, better known as diphtheria.

Diphtheria is one of those diseases we think about in the same way we think about cholera, typhoid, and consumption (TB). We think of it as a disease that people used to die from on The Oregon Trail, but that it’s not actually a thing anymore. Except that it is.

In the 1930s, diphtheria killed between 13,000 and 15,000 individuals annually in the United States. A diphtheria vaccine was developed in the 1920s, and became widely available in the ‘40s and ‘50s. The disease’s prevalence rate dropped off to a statistical zero by the 1980s.   Most people are vaccinated against diphtheria in childhood as a part of the DTaP vaccine, which protects against diphtheria, tetanus and pertussis (whooping cough). People older than the age of 11 need a Tdap booster shot every seven to nine years. The differences between the DTaP and Tdap vaccines are the antigen concentrations in each shot.

Diphtheria InfocardDiphtheria is in the news again due to a cluster of cases in Spain; in the Girona province of Catalonia, Spain (very close to the border of France), the index case (“patient zero”) is an unvaccinated little boy. Heartbreakingly, as of the writing this post the boy is in critical condition on life support, and his parents have expressed that they “feel terrible guilt” over not vaccinating their son and feel hoodwinked by the antivaccine community. Several months ago Tara Hills, a mother of seven, wrote on our blog about the guilt she felt after not vaccinating her children and their subsequent battle with whooping cough.

While the index patient in Spain was not vaccinated, initial reports of the subsequent eight infections indicate that the other patients were vaccinated. The reports, however, don’t indicate the age of the new patients (diphtheria is particularly virulent in those under age five) or if the eight had completed the World Health Organization’s full vaccination schedule. Additionally, those who have been vaccinated against diphtheria tend to develop a milder form of the disease as their bodies already have some of the antibodies needed to fight the bacteria and the toxin.

Treating diphtheria is complicated, many impacting factors including the age of the individual, their vaccination status, when in the disease’s progress they sought medical treatment, and how the bacteria entered the body can all vary the severity of the illness. Prevention is the first line of defense (get your shots, people!) but once infected, antitoxins, antibiotics and supportive care are the standard treatment. Complicating matters even further is that the diphtheria antitoxin is not a standard drug that hospitals keep on hand. In fact it’s only available through the CDC directly for us here in the US. The antitoxin also won’t neutralize existing pockets in the mucus membranes, it will only prevents the progression of the disease by neutralizing the toxin that’s circulating in the bloodstream. This is why the death rate from diphtheria remains so high.

As Rene Najera pointed out on Monday, many diseases are just a plane ride away. This disease could even easily spread to areas of southern France given its proximity to the border and the nature of cross-European transit, which is largely train and short-flight based. Even if you don’t plan to travel to Spain any time soon, now may be a good idea to check in with your doctor and make sure you and your family are up to date on your Tdap and DTaP shots. Heck, most health departments give them away for free (FREE!).

Editor’s note: Since the publication of this post, the little boy has since passed away. You can read more here.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

Is It Time to Freak Out About MERS?

By June 8, 2015 3 Comments
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Middle Eastern Respiratory Syndrome virus (MERS) is a nasty infection and one you definitely don’t want to get. A recent outbreak of Middle Eastern Respiratory Syndrome virus (MERS) in Korea has a lot of people on edge, and for good reason. But what are the chances that you, sitting at home in the United States and other countries where MERS is not active, will get MERS? What are the chances that it will spread like wildfire and make many people sick and kill even more? And is it really that deadly? Let’s take these questions one by one and separate fact from worry.

According to the Centers for Disease Control and Prevention (CDC), the signs and symptoms of MERS are fever, cough, and shortness of breath. Those symptoms sound similar to just about any upper respiratory tract infection, but complications from MERS include kidney failure and severe pneumonia. Partly due to these complications, between 30% and 40% of patients with MERS cases have died, which is a very high mortality rate. Currently there isn’t a specific treatment for MERS, much like a cold or a stomach bug, treatment is supportive (fluids, fever reducers, pain killers etc…). The high mortality rate is why public health agencies across the world are on high alert.

Good for us (bad for MERS) unlike the flu or the measles, it turns out MERS isn’t easy to catch.

The MERS virus is a variant of the corona virus, a virus that has many different strains and causes different kinds of respiratory and gastrointestinal diseases. You’ll sometimes see “MERS” written as “MERS-CoV,” with “CoV” meaning “coronavirus.” Because the MERS strain of coronavirus is relatively new to humans, scientists are still working on fully understanding how it is transmitted.

One thing is for sure, close contact between people leads to transmission. Close contact can include healthcare providers caring for people with MERS and not using appropriate personal protective equipment or infectious disease precautions. Some of these providers not using those precautions have been infected. Also, people hospitalized with MERS patients have been infected, suggesting that the virus is spread via aerosols (e.g. sneezes and coughs) or is airborne (e.g. through breathing the same air).

MERS-CoV Infographic copyI mentioned before that MERS has a mortality rate between 30% and 40% and the high hospital transmission rate may be over-inflating the virus’ actual mortality rate. People who are already in the hospital for another illness or condition and contract MERS are likely to have more complications and worse outcomes (and a higher mortality rate).

Because MERS is so new (and until now has been relatively contained) disease surveillance systems have been only picking up cases that are hospitalized. It will likely take a while before systems are in place to detect sub-clinical cases (i.e. cases who don’t become sick enough to seek hospital care).

With that said, you may remember the H1N1 pandemic several years ago. In the US alone, thousands of people became so sick they sought care from their doctors and hospitals. We aren’t seeing this with MERS, which tells us that MERS is either a mild virus in those who are otherwise healthy or isn’t easily transmitted at the community level.

According to the Korean Ministry of Health, the first person identified in the current outbreak (what we call in public health the index case) was reported as having traveled recently to the Middle East. Seven days after his arrival, the index case sought care at different healthcare facilities in Korea, likely spreading the virus in those settings.

Taking all of this into consideration, it is very possible that MERS could spread to other parts of the world past Korea, in fact, there have already been cases in the United States. These cases in the US were unconnected and over 500 people were potentially exposed, but no one contracted the virus outside of the index cases.

We live in a world where a jet can depart the Middle East and be in any part of the world in a matter of hours. Combine that with the incubation time (time for symptoms to develop from the initial exposure) that MERS is displaying of about 2 to 14 days, and you could have plenty of cases popping up all over the globe.

So what is keeping that from happening?

First, it seems that exposure to camels or camel products (like milk) were the primary source of MERS infections in the Middle East. Second, modern healthcare facilities have strict infection control protocols that may be keeping infections from occurring within them. Third, as I mentioned above, the person-to-person transmission in the community – outside of healthcare facilities – seems to be limited.

In the United States, between 3,000 and 49,000 people die from influenza each year. Half a million of us die from smoking-related diseases like lung cancer, high blood pressure, and heart disease. Another half a million will die from heart disease associated with poor diet and lack of physical activity. And over 30,000 will die from traffic-related accidents. At this time and in the United States, MERS is on our public health radar, but in your day-to-day life it should be your least concern.

The best things you can do for your health (and others) are to wash your hands, eat a balanced diet, wash your hands, get plenty of exercise and plenty of rest, wash your hands, and follow your healthcare providers advice at all times, buckle-up in the car, and wash your hands. Also, don’t forget to wash your hands.

Edited by Leslie Waghorn

 

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

What We Could Learn From Sweden

By February 19, 2015 No Comments
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I recently listened to a radio interview comparing Sweden to the US with regard to vaccination rates. I should emphasize the fact that the two countries share very little in common when it comes to healthcare, which naturally informs the average citizen about their medical choices BUT one detail stood out to me. Herd Immunity.

For years it was a term limited to my geeky global health cohort, but in Sweden, the ethos of herd immunity is on the minds of most average citizens.

A study by Björn Rönnerstrand published in The Scandinavian Journal of Public Health in 2013 investigated the connection between social capitol indicators and immunization during the 2009 H1N1 influenza season.

The takeaway?

Swedes who opted to vaccinate had higher levels of trust – trust in the healthcare system and in society. (Again, we share very little in common) What blew my mind was reading that the Swedish Institute for Communicable Disease Control created this slogan: “Be vaccinated to protect your fellow citizens.”  A slogan!  An others-focused slogan! Beyond promoting individual protection, this was about caring for others and ensuring communities felt secure.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health