[Health] The Infectious Diseases Thread

[Isgrimnur]

Time

Most Americans have, at one point or another, removed hair from down there. But new research suggests that the grooming practice is linked to a major downside: an increased risk of STIs, or sexually transmitted infections.

In a new study published in the journal Sexually Transmitted Infections, researchers surveyed thousands of Americans about their sexual history, grooming habits and whether or not they’d ever had an STI.
...
Groomers tended to be younger, more sexually active and to have more sexual partners than non-groomers. They were also more likely to report having an STI in their life, including herpes, HPV, syphilis, gonorrhea, chlamydia or HIV. Even after the researchers adjusted factors that were influencing the association, like a person’s age and number of sexual partners, a link remained.

The more people frequently people groomed, the stronger the association. People who groomed daily or weekly were about 3.5 to 4 times more likely to report having an STI history.

The results don’t imply that shaving, waxing or trimming will increase a person’s chances of getting an STI. This kind of cross-sectional study is just a snapshot in time, making it impossible to determine cause and effect or even to tell which came first: the grooming or the infection.

Furthermore, people weren’t required to have a medically confirmed STI, and self-reported sexual histories are not always reliable, says lead author Dr. Charles Osterberg, assistant professor of surgery at the University of Texas Dell Medical School.

But the observational study, which Osterberg describes as the largest one yet to look at grooming patterns in the U.S., raises some interesting questions about the link. It’s possible that when grooming causes microtears, bacterial and viral STIs are better able to penetrate the skin. Or maybe grooming is a sign that a person is more likely to have risky sex, the authors write. If that’s true, Osterberg says, “if a clinician were to see evidence of grooming upon physical examination, perhaps that physician should inquire about safer sex practices or a sexual history.”

[Max Peck]

The Latest Zika News Is More Bad News

It’s been a busy week for Zika news. Local spread of Zika virus in Brownsville, Texas, led to a travel advisory for the area this week, just as multiple studies were published detailing what percentage of fetuses are affected among women who are infected during pregnancy and how the virus spreads.

A new study published in the New England Journal of Medicine found that in Rio de Janeiro, 42 percent of women infected with Zika during pregnancy were found to have given birth to infants with severe abnormalities. A second study from the U.S. Centers for Disease Control and Prevention found that among pregnant women with potential Zika infection in the U.S., 11 percent had a fetus or infant with a birth defect. There are several potential explanations for the discrepancy: Anomalies from in utero exposure to Zika have shown up well after birth in some cases, and the Brazil study had a longer follow-up period, meaning that they may have caught more of the later manifestations. Additionally, the Brazil study is only tracking women with symptomatic cases of Zika, and scientists have hypothesized that those showing symptoms, which is just a fraction of all infections, may be more likely to have babies with abnormalities. Infants in Brazil are also generally more likely to be born with abnormalities than those in the United States. This week, researchers at the CDC also found evidence of how Zika virus replicates in fetal brains, causing microcephaly and other neurological disorders.

The severity of the threat of Zika on pregnant women and newborns puts Cameron County, where Brownsville is located, in a tough position. After five people tested positive for Zika in an eight-block area, the CDC, Texas Department of State Health Services and the Cameron County Department of Health and Human Services all recommended that women in Brownsville talk with their doctors if they are thinking about getting pregnant and be tested for Zika if they are pregnant. That’s good advice, but many women in Cameron County don’t appear to have a doctor; around a quarter of women in Cameron receive little to no prenatal care, according to Texas Kids Count, a project funded by the Annie E. Casey Foundation that tracks child and maternal health. And though we don’t have data by county, Texas has one of the highest rates of unintended pregnancy of any state. And the county overall has limited access to health care — 40.7 percent of working age adults are uninsured, according to Texas Medical Association estimates of Census Bureau data.

The state is currently working with the county on how to make Zika testing available to the many people who don’t have insurance, according to Chris Van Deusen, director of media relations for the Texas DSHS.

[gilraen]

Mumps outbreak in Washington state - 80 confirmed cases across 4 school districts, number expected to go up.

[Smoove_B]

Even closer - be careful my metro Denver OOers - Mumps outbreak is happening:

According to information posted by Westminster Fire Department, six residents in northeast Denver and northwest Aurora have the mumps.

“The number of cases likely is higher as mumps cases often go undetected or untested,” the said.

[The Meal]

Symptoms of the mumps, according to the Centers for Disease Control, include fever, headache, muscle aches, tiredness, loss of appetite, and swollen and tender salivary glands around the ears.

For how long does the MMR inoculation provide benefit? IIRC, it's ten years? I'm most probably due.

edit to add:

2. Measles, mumps, rubella (MMR) vaccination. Measles component: adults born before 1957 can be considered immune to measles. Adults born during or after 1957 should receive >1 dose of MMR unless they have a medical contraindication, documentation of >1 dose, history of measles based on health-care provider diagnosis, or laboratory evidence of immunity. A second dose of MMR is recommended for adults who 1) were recently exposed to measles or in an outbreak setting; 2) were previously vaccinated with killed measles vaccine; 3) were vaccinated with an unknown type of measles vaccine during 1963--1967; 4) are students in postsecondary educational institutions; 5) work in a health-care facility; or 6) plan to travel internationally. Withhold MMR or other measles-containing vaccines from HIV-infected persons with severe immunosuppression. Mumps component: 1 dose of MMR vaccine should be adequate for protection for those born during or after 1957 who lack a history of mumps based on health-care provider diagnosis or who lack laboratory evidence of immunity. Rubella component: administer 1 dose of MMR vaccine to women whose rubella vaccination history is unreliable or who lack laboratory evidence of immunity. For women of childbearing age, regardless of birth year, routinely determine rubella immunity and counsel women regarding congenital rubella syndrome. Do not vaccinate women who are pregnant or who might become pregnant within 4 weeks of receiving vaccine. Women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health-care facility.

[Kraken]

Bah. Been there, had that.

[AWS260]

Leptospirosis.

New York City is investigating three recent cases — one of them fatal — of a rare disease transmitted through rat urine that have occurred in the Grand Concourse neighborhood of the Bronx, according to the Department of Health and Mental Hygiene.

This is the first time a cluster of the cases of the disease, leptospirosis, has been identified, according to an alert issued by the department on Tuesday. From 2006 to 2016, 26 cases were reported in the city; the Bronx had the highest number, eight.

The three most recent cases occurred in the past two months. All the patients became severely sick and were hospitalized with acute kidney and liver failure, the health department said. One died as a result of an infection. The two who survived have been released from the hospital.

Note to self: stop drinking rat urine.

[Smoove_B]

Yeah, I was reading up on it this morning....because that's what I do while most normal people get updates on Beyonce or Brad Pitt. Death is pretty rare, I'm guessing the individual had other underlying medical conditions. It's also something I wouldn't expect to see multiple cases of outside of an emergency situation where the likelihood of rat/human interactions would increase (natural disaster, fire, flooding, etc...). The place where this happened must be absolutely overrun with rats.

[coopasonic]

Note to self: stop drinking rat urine.

Are you just going to ignore the potential health benefits just because of something you read on the internet?

[Jeff V]

Yeah, I was reading up on it this morning....because that's what I do while most normal people get updates on Beyonce or Brad Pitt. Death is pretty rare, I'm guessing the individual had other underlying medical conditions. It's also something I wouldn't expect to see multiple cases of outside of an emergency situation where the likelihood of rat/human interactions would increase (natural disaster, fire, flooding, etc...). The place where this happened must be absolutely overrun with rats.

So it's okay for most of us to still drink rat urine aka Miller Lite?

[Smoove_B]

So it's okay for most of us to still drink rat urine aka Miller Lite?

Probably most safe. It's not like you live in Hawaii or Florida, right?

EDIT: Though I guess if I were also being honest, I'd advise against it if you live in the American West and South West too. Sin Nombre virus is still a thing.

DOUBLE EDIT: Maybe I should just stick with the CDC on this one and suggest you avoid both rat urine and Miller Lite. Probably for the best.

[Isgrimnur]

When are they going to get around to renaming it?

Spoiler:

Because it was discovered near the Four Corners point in the United States, its original name was "Four Corners virus". The name was changed after local residents raised objections.

[Smoove_B]

The did - it's the Sin Nombre Virus (SNV).

[Isgrimnur]

Third base!

[LordMortis]

http://www.npr.org/sections/goatsandsod ... -northeast

Have Fun this summer! If I had animals, I think I'd have free range egg laying chickens right about now.

[Smoove_B]

Or you could finally live your dream of having an Opossum farm.

[Smoove_B]

I tried warning everyone about Rat Lungworm, but you didn't listen. Well, I at least someone at the Atlantic is listening:

The parasite that causes rat lungworm disease is now endemic in the southeastern United States, and it’s expected to spread northward.

...

Rat lungworm has long been prevalent in parts of Asia and the Caribbean—the first human case of the disease was recorded in Taiwan in 1944—but only recently has it been identified routinely in the United States, including in Hawaii, California, Alabama, Louisiana, Florida, and elsewhere along the Gulf Coast, according to a 2015 study in the Journal of Parasitology. The geographical distribution of this disease has “changed dramatically” in just a few decades, wrote the authors of a separate study, published in the Hawaii Journal of Public Health in 2013.
...

Rat lungworm disease is notoriously hard to diagnose, largely because there is no blood test that can confirm an infection. (Usually, doctors can determine whether someone is infected based on a patient’s symptoms and exposure history, or a test of cerebrospinal fluid.) There’s no treatment for the disease, though patients are often given painkillers to manage symptoms. Rat lungworm disease can resolve on its own, once the worms die, but in some cases it is fatal.

[Isgrimnur]

Zika

Beyond its known links to birth defects and other problems, the Zika virus may also trigger cases of epilepsy in infants, warn experts from the U.S. Centers for Disease Control and Prevention.

Among 48 babies from Brazil with probable congenital Zika infection, “50 percent reportedly had clinical seizures,” said Dr. Daniel Pastula, Dr. Marshalyn Yeargin-Allsopp and Rosemarie Kobau.
..
Right now, parents and health care professionals may not be aware of the Zika-epilepsy link, the CDC researchers said, so cases “may be misdiagnosed or under-reported.”

The researchers believe that heightened awareness will be key to spotting cases of epilepsy linked to fetal exposure to Zika and helping babies.

In a statement, the CDC said that “better recognition, diagnosis, and reporting of seizures and epilepsy in infants and young children will help guide interventions to make sure families receive the right support and treatment.”

[Smoove_B]

Guess who's back for the summer? Maybe Ebola...

A person in Democratic Republic of Congo who died of a hemorrhagic fever has tested positive for the Ebola virus, signaling the start of a new outbreak, the Health Ministry and the World Health Organization (WHO) said on Friday.

The case was confirmed from tests on nine people who came down with a hemorrhagic fever in Bas-Uele province in the northeast of the country on or after April 22, a ministry statement said. Three people have died of fever.

Hopefully we do a better job this time responding.

[Isgrimnur]

HepC on the rise:

New hepatitis C virus infections in the United States nearly tripled between the years 2010 and 2015.

The number of new nationally reported infections with the virus swelled from 850 in 2010 to 2,436 cases in 2015, with the highest rates among young people, mainly 20- to 29-year-olds, who inject drugs, according to a new report released Thursday by the Centers for Disease Control and Prevention.

However, the CDC estimates the true number is much higher-- about 34,000 new infections nationally for 2015 -- since hepatitis C has few symptoms and most newly infected people do not get diagnosed.

An estimated 3.5 million people, mainly baby boomers, in the United States currently have an infection with hepatitis C, which damages the liver. Symptoms can include fever, abdominal pain, loss of appetite, nausea, vomiting, joint pain and jaundice. Last year, the agency reported a record number of fatalities from the virus occurred in 2014.

"Recent CDC research has identified increasing injection drug use -- tied to the US opioid epidemic -- in rural and suburban areas across the country," said Dr. John Ward, an author of the new report and director of the division of viral hepatitis at the CDC.

[stessier]

Guess who's back for the summer? Maybe Ebola...

A person in Democratic Republic of Congo who died of a hemorrhagic fever has tested positive for the Ebola virus, signaling the start of a new outbreak, the Health Ministry and the World Health Organization (WHO) said on Friday.

The case was confirmed from tests on nine people who came down with a hemorrhagic fever in Bas-Uele province in the northeast of the country on or after April 22, a ministry statement said. Three people have died of fever.

Hopefully we do a better job this time responding.

A likely outcome given the strong government leadership we have right now.

[Smoove_B]

HepC on the rise

Been watching this slowly balloon over the last 7+ years. Unless the data is different, since 2010 more people are dying of HepC each year than HIV, with 75%+ of them between the ages of 45-64. Medication to try and cure infected people runs around $60-90K. It's insane.

[$iljanus]

HepC on the rise

Been watching this slowly balloon over the last 7+ years. Unless the data is different, since 2010 more people are dying of HepC each year than HIV, with 75%+ of them between the ages of 45-64. Medication to try and cure infected people runs around $60-90K. It's insane.

That's pretty expensive. Into the high risk you go!

[Jeff V]

HepC on the rise

Been watching this slowly balloon over the last 7+ years. Unless the data is different, since 2010 more people are dying of HepC each year than HIV, with 75%+ of them between the ages of 45-64. Medication to try and cure infected people runs around $60-90K. It's insane.

That's pretty expensive. Into the high risk you go!

It's part of the DontCare plan to reduce the numbers of high risk and uninsured. Don't insure them, let them die off, and problem solved! No uninsured, no expensive high-risk patients bogging down the system.

[Isgrimnur]

Don't drink, ink, and swim.

Dallas

Doctors say a Dallas man made a deadly mistake before taking a trip to the beach.

According to an article recently published in BMJ Case Reports, the 31-year-old man died after the bacteria vibrio vulnificus entered his body through a new leg tattoo.

The report says the man obtained the leg tattoo five days before swimming in the Gulf of Mexico, where vibrio vulnificus can be found in high levels during the summer months.

Treating physicians, including Dr. Nicholas Hendren of UT Southwestern Medical Center, say the man arrived at Parkland Memorial Hospital three days after exposure with extreme pain in his leg.

"Very quickly, over a couple of hours, it began to get more discolored, more bruised and had large blisters that began to form, which was certainly alarming to us as it was to him," Hendren said.

Hendren's report says the man had chronic liver disease and told them he drank six beers a day.

People with a weakened immune system, a liver disease/condition or an iron-related disorder are especially vulnerable to serious infection from the bacteria.
...
The reports says the man was extubated on the 18th day of admission and began aggressive rehabilitation.

"Unfortunately, his clinical status subsequently deteriorated, ultimately leading to his death due to a myriad of complications related to cirrhosis, renal failure and necrotic skin lesions approximately 2 months after admission," Hendren said.

Dallas tattoo artist Caleb Barnard did not know the victim, but he says the incident should serve as a reminder about tattoo safety.

"Stay out of the ocean. Stay out of the river. Stay out of the lake. Stay out of the pool. Stay out of the hot tub," Barnard said, about caring for a fresh tattoo in the first two weeks.

[Stefan Stirzaker]

Anyone else been keeping an eye on Plague this year in Madagascar? Lots of Pneumonic plague (black death version) which is unusual.
https://reliefweb.int/report/madagascar ... tober-2017

1. Situation update

The outbreak of plague in Madagascar continues to evolve. Since our last report on 4 October 2017, a total of 230 new suspected cases including 17 deaths (case fatality rate 7.4%) were reported. Between 1 August and 8 October 2017, a total of 387 cases (suspected, probable and confirmed) including 45 deaths (case fatality rate 11.6%) have been reported from 27 out of 114 districts in the country. Of these, 277 cases (71.6%) had the pneumonic form of the disease, 106 were bubonic plague, one case was septicaemic plague, and 3 cases were unspecified. Of 279 cases reported to the Central Plague Laboratory of the Institut Pasteur of Madagascar, 38 were confirmed by polymerase chain reaction (PCR), 113 were classified as probable cases after testing positive on rapid diagnostic tests (RDT) and 123 remain suspected cases, pending results. Fourteen (64%) out of 22 regions in the country (including the North and South-east Regions that are considered non-endemic) have been affected. At least eight healthcare workers from one district health hospital have contracted plague since 30 September 2017.

Plague is known to be endemic on the Plateaux of Madagascar (including Ankazobe District where the current outbreak originated) and a seasonal upsurge (predominantly the bubonic form) usually occurs early every year between September and April. Unlike the usual endemic pattern, the plague season begun early this year, and the current outbreak has affected major urban centres, including Antananarivo (the capital city) and Toamasina (the port city).

There are three forms of plague, depending on the route of infection: bubonic, septicaemic and pneumonic (for more information, see the link).

Date / Cases / Deaths
14 Sep 2017 / 28 / 5
30 Sep 2017 / 73 / 17
3 Oct 2017 / 194 / 30
5 Oct 2017 / 258 / 36
7 Oct 2017 / 343 / 42
8 Oct 2017 / 387 / 45.

[Jeff V]

Smoove can elaborate, but I thought plague was pretty treatable with modern medicine. These outbreaks happen time to time in 3rd world countries that are still technologically stuck in the middle ages.

[Smoove_B]

Anyone else been keeping an eye on Plague this year in Madagascar?

/slowly raises hand

There's also a Cholera epidemic ripping through Yemen - 800,000+ cases since April of this year. It's mind-boggling.

[Smoove_B]

Smoove can elaborate, but I thought plague was pretty treatable with modern medicine. These outbreaks happen time to time in 3rd world countries that are still technologically stuck in the middle ages.

It is - and we see cases here in the United States. pneumonic plague is still rare here but I think we see around 10 cases of bubonic plague on average. With the rodent and insect vectors in the United States, there seems to be environmental factors at play we don't understand. I can't speak to what's happening in Madagascar it seems like it's setting off flags because it's happening earlier and in places normally not seen (urban areas). The same type of red flags would be up if plague suddenly appeared in NJ or Delaware - it's just not something we see around my part of America. Regardless, I don't know enough about what's happening with the local environment in Madagascar to comment, but I've been following it because of the size and scope - it's definitely newsworthy.

[Jeff V]

Well, with the anti-science Republican party in charge, some plague is gonna ravage us one of these days. It just probably won't be THE plague.

IIRC, the bubonic plague is spread directly by fleas on infected rats. The pneumonic plague is a mutation that allows the disease to spread person-to-person, mostly by coughing or sneezing. Cities have the population density for pneumonic plague to take hold -- the bubonic variety is often more rural.

[Smoove_B]

Bubonic/pneumonic isn't a factor of rural vs urban. It's just simply how the bacteria ultimately presents itself in your body. If they make their way from your blood and lymph (which causes the buboes to emerge under your arms or in your groin) into your lungs it now goes from non-communicable to communicable. So when you get it from a flea bite, it will initially present as bubonic. You go to the doctor and get treatment; no one else gets stick. But if you're around someone that has pneumonic plague - or maybe even a dog and that person (or animal) is coughing and sneezing the bacteria out into the environment...trouble - because now it's mainlined right into your lungs and you then become sick with pneumonic plague and kick it back out to other people. There's no mutation involves - same bacterial strain causes different variety of illness depending on where it sets up shop.

During WW2 the Japanese were testing plague-laced flea bombs on (mostly) Chinese victims - and it worked. But giving people bubonic plague in a war situation isn't the worst. When WW2 ended, the Russians and Americans took the notes of the Japanese teams that were working on this and developed a way to aerosolize the bacteria in a weaponized format, transmitting the much deadlier version. If you're looking for something to read up on, it's Unit 731.

[Stefan Stirzaker]

Anyone else been keeping an eye on Plague this year in Madagascar?

/slowly raises hand

There's also a Cholera epidemic ripping through Yemen - 800,000+ cases since April of this year. It's mind-boggling.

Yeah it's quite astounding, I used to work in communicable diseases areas so still keep Pro-Med mail subscription going to keep an eye on things, as I still find it fascinating. Cholera is insane numbers Plague is so different this year from previous years and still no understanding of why there, but with 50 cases a day and 2/3 pneumonic I can't see it stopping quickly unless they get their detection going and spread stopped. Though I did see one report that it's been made more complicated by funeral practices with families insisting on taking infected corpses back to home burial areas and/or digging up the corpse from plague graves to perform funeral services.

I think all forms except scepticemic respond well to antibiotics if caught in time though Madagascar was also the home of the antibiotic resistant strain a few years ago.

[Jeff V]

Thanks for the info, Smoove! Obviously my knowledge is incomplete, thanks for filling the gaps!

[Smoove_B]

Thanks for the info, Smoove! Obviously my knowledge is incomplete, thanks for filling the gaps!

It's not often I get to talk about what I know here, so when I can, I do.

Though I did see one report that it's been made more complicated by funeral practices with families insisting on taking infected corpses back to home burial areas and/or digging up the corpse from plague graves to perform funeral services.

That's interesting - I hadn't seen that. Reminds me of the trouble they had trying to stop Ebola a few years back because of the funeral practices. Viral amplification soars with near-death and then (I think) for a while after death -- totally against what you'd normally expect. It puts anyone handling the remains (particularly family members observing cultural funeral practices) at increased risk for infection. I'll need to look into that some more for plague too, thanks.

[Isgrimnur]

There are more posts about diseases than there are programming questions.

[Stefan Stirzaker]

Thanks for the info, Smoove! Obviously my knowledge is incomplete, thanks for filling the gaps!

It's not often I get to talk about what I know here, so when I can, I do.

Though I did see one report that it's been made more complicated by funeral practices with families insisting on taking infected corpses back to home burial areas and/or digging up the corpse from plague graves to perform funeral services.

That's interesting - I hadn't seen that. Reminds me of the trouble they had trying to stop Ebola a few years back because of the funeral practices. Viral amplification soars with near-death and then (I think) for a while after death -- totally against what you'd normally expect. It puts anyone handling the remains (particularly family members observing cultural funeral practices) at increased risk for infection. I'll need to look into that some more for plague too, thanks.

No problems, always good to talk to interested people, I thought it was very similar to ebola too, but ebola only needs a cut or mucus membrane, while you would need to breath it in to be pneumonic, from the corpse. This was my source:
Source: L'Express Madagascar [in French, machine trans., edited] http://www.lexpressmada.com/blog/actual ... es-voles/>

[Smoove_B]

Just saw this Ask The Disease Specialist: Why Is It So Hard To Beat The Plague? I think it's an interesting piece and I love this quote:

It's easy when we see the emergency to say, "People are so stupid. Why didn't they handle the rodents so they wouldn't have this problem?" But, of course, you know these are the challenges that the public health administrators and ministers of health and research are faced with everyday: How do you balance the many, many needs and the always limited resources?

[Blackhawk]

I blame the anti-ratters.

[Isgrimnur]

They’re just a response to the alt-rat.

[$iljanus]

A more ratical solution is called for.