[Health] The Infectious Diseases Thread

[Isgrimnur]

Costco

The strain of E. coli linked to Costco chicken salad that sickened 19 people in seven states is more likely to be life-threatening than a recent outbreak that closed some Chipotle restaurants in the Northwest.

Health officials urged people who bought chicken salad at any U.S. Costco store on or before Friday to throw it away, even if no one has gotten sick.

The strain of Shiga toxin-producing E. coli can be life-threatening, but no deaths have been reported. Five people have been hospitalized and two have developed a type of kidney failure, the Centers for Disease Control and Prevention said.

The CDC and state health officials were investigating and have not yet determined what ingredient in the rotisserie chicken salad made and sold in Costco Wholesale stores could be the source of the outbreak.

Six people have fallen ill in Montana, five in Utah, four in Colorado, and one each in California, Missouri, Virginia and Washington state. The CDC said the illness reports began on Oct. 6 and involved people from age 5 to 84.

[Isgrimnur]

Brazil

Brazilian health authorities are sounding the alarm about a mosquito-borne virus that they believe may be the cause of thousands of infants being born with damaged brains.

The pathogen, known as Zika and first discovered in forest monkeys in Africa over 70 years ago, is the new West Nile -- a virus that causes mild symptoms in most but can lead to serious neurological complications or even death in others. Brazil's health ministry said on Nov. 28 that it had found the Zika virus in a baby with microcephaly — a rare condition in which infants are born with shrunken skulls — during an autopsy after the child died. The virus was also found in the amniotic fluid of two mothers whose babies had the condition.
...
Brazil is investigating more than more than 2,400 suspected cases of microcephaly and 29 deaths of infants that occurred this year. Last year the country saw only 147 cases of microcephaly.

The situation in Brazil is so overwhelming that Angela Rocha, a pediatric infectious diseases specialist in Pernambuco, one of the hardest hit states, said in an interview with CNN that women may want to hold off on getting pregnant.
...
Until a few years ago, human infections with the virus were almost unheard of. Then, for reasons scientists can't explain but think may have to do with the complicated effects of climate change, it began to pop up in far-flung parts of the world. In 2007, it infected nearly three-quarters of Yap Island's 11,000 residents. In 2013, Zika showed up in Tahiti and other parts of French Polynesia and was responsible for making an estimated 28,000 people so ill they sought medical care. It arrived in Brazil in May, where tens of thousands have fallen ill.

The World Health Organization, which has been monitoring the spread of the virus closely and issued an alert about the situation in Brazil, reported this month that it had popped up for the first time in the West African nation of Cape Verde and that it had led to additional illnesses in Panama and Honduras.

[Isgrimnur]

Zika on the move:

Zika virus is also spreading quickly. By October cases had been reported in Colombia, El Salvador, Guatemala, Mexico, Paraguay, Panama, Suriname, and Venezuela. The region to fall victim this week is Puerto Rico.
...
Zika viruses has been found in the US among travelers who have been to affected regions, but there is as yet no locally transmitted case there. With no treatments or preventative medicine at hand, the US Centers for Disease Control and Prevention’s suggestion is to follow steps to prevent mosquito bites: carry insect-repellent creams, wear long sleeves and pants, sleep in air-conditioned rooms or behind windows with screens.

[Isgrimnur]

Blue Bell Listeria

Blue Bell says it has found "suspected Listeria species" at it's [sic] facility.

The Brenham-based company did not specify which facility was affected in a statement released Thursday, but it stressed that none of its products have tested positive for the infection.

The company says it expects to find small indications of Listeria from time to time but their top priority is eliminating potential sources of contamination. The company credits its new testing system for detecting what it calls "microbiological indications" of Listeria.

Blue Bell says no manufacturer can assume Listeria can be destroyed entirely because it's commonly found in the natural environment.

[LawBeefaroni]

Seems like this is happening a lot at Blue Bell. Probably time for a name change there.

Or am I misremembering?

[Isgrimnur]

Nope. This is the, "Almost ... there ..." announcement.

[LawBeefaroni]

Chipotle is going to shut down for a day in February to have a health rally for workers.

The meeting will occur on February 8 and the company's more than 1,900 restaurants will take part.

Chipotle said the meeting would provide an opportunity to thank employees, discuss changes and answer questions.

Chipotle (CMG) has suffered from several outbreaks of E. coli, Salmonella and norovirus that infected customers and led to an unrelenting stream of criticism and mockery on social media.

...



The trouble began in August when 64 customers in Minnesota were infected with Salmonella and about 100 people were struck by norovirus in southern California.

These infections were followed by an E. coli outbreak in October and November that affected 53 people in nine states.

In December, Chipotle suffered from two more outbreaks. Roughly 140 students at Boston college were infected with norovirus and a second new incidence of E. coli broke out affecting five people in three states.

The trouble didn't end with the outbreaks however. Customers have sued Chipotle and the company was recently served with a subpoena by the U.S. Food and Drug Administration's Office of Criminal Investigations.

[Isgrimnur]

WaPo

The rapid spread of the Zika virus has prompted Latin American governments to urge women not to get pregnant for up to two years, an extraordinary precaution aimed at avoiding birth defects believed to be linked to the mosquito-borne illness.
...
After more than 5,000 suspected Zika cases were reported last year and in the first weeks of 2016, El Salvador on Thursday took the most extreme stance so far: Deputy Health Minister Eduardo Espinoza urged women to refrain from getting pregnant before 2018. The Central American nation saw its first suspected Zika cases in November and sent samples to the United States to be tested for the virus, Espinoza said in an interview.
...
A campaign to delay pregnancy would seem to be an implicit endorsement of birth control. For a region that is majority Roman Catholic, this presents a potential conflict, as the church has long condemned contraception. The Rev. Hector Figueroa, a priest in charge of health issues in the San Salvador archdiocese, said that the pregnancy alert appeared in the Salvadoran news media Friday morning and that the archbishop had not had time to formulate an official response.

“Morality says that people shouldn’t have that control” over procreation, Figueroa said. “But the church also isn’t going to say something that runs contrary to life and health.”

[Isgrimnur]

WaPo

The World Health Organization announced Thursday that it will convene an emergency meeting to try to find ways to stop the transmission of the Zika virus — which officials said is "spreading explosively" across the Americas.
...
Health officials said 23 countries are affected by mosquitoes that are spreading the virus locally. The Centers for Disease Control and Prevention said the United States has 31 confirmed cases in 11 states and the District of Columbia. All are travel-related, the CDC's Lyle Petersen said, and "this number is increasing rapidly." The country also has 20 additional cases because of local transmission in U.S. territories — 19 in Puerto Rico and one in the U.S. Virgin Islands.
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During a briefing to the WHO executive board on Thursday, Brazil’s health minister, Claudio Maierovitch, said the country is investigating 12 confirmed deaths of babies born with microcephaly for potential linkage with Zika virus infection. The country has more than 4,000 suspected cases of microcephaly. Some of those have turned out not to be microcephaly, but many of them have been confirmed through ultrasound, he said. He did not provide a figure. Pregnant women who tested positive for the Zika virus have had a rash and fever during the “first and second parts of their pregnancy,” he said.
...
The WHO said the reason Zika appears to be spreading so rapidly is two-fold: One, because it is a new disease to the region, the population does not have immunity and two, the Zika virus is primarily transmitted by a mosquito species known as A. aegypti, which lives in every country in North and South America except for Canada and Chile.

WHO officials said that this type of mosquito also has been simultaneously carrying a host of other viruses — dengue, Chikungunya, yellow fever, West Nile — to those regions in recent years. Among the hypotheses scientists are looking are whether the recent severe reactions may be related to co-infection with Zika and another virus, or previous exposure to one.
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Part of the challenge with Zika is that it is often "silent" with up to 75 percent of patients who are infected having no symptoms, said Sylvain Aldighieri, who works in epidemic alert and response for the WHO/PAHO. "We have big gaps in terms of confirmation of the real situation."

[Smoove_B]

The other article I saw this morning was suggesting that maybe another reason it's spreading so quickly is that the Aedes aegypti mosqutio isn't the only one spreading it. They're doing a quick study to see if they can find it in the Culex pipiens mosquito population, which if they find, could be quite troubling.

The A. aegypti mosquitoes are floodwater mosquitoes typically seen in tropical or sub-tropical climates. The C. pipiens mosquito has a much wider range and is the one most people (at least those living in more moderate climates) are familiar with. If the Culex species are spreading it too...I'm not saying it's time to panic, but the scope of the problem will have increased significantly.

[Isgrimnur]

WHO: Global Health Emergency

The World Health Organization declared today that the Zika virus has reached the status of a global emergency.

By deciding to declare that the mosquito-borne virus is a "public health emergency of international concern," it allows more money, resources and scientific research to be dedicated to addressing the growing disease.

The last time that the international organization used such a classification was the Ebola outbreak in West Africa in 2014.

Comments, as always, a gold mine.

I do not trust that a "new" virus has emerged, I think a new vaccine opportunity has emerged. BRIC... oh let us "help" you.... ("Help them, what do you mean 'help' them?") -
...
now they can spray whatever they want and line everybody up for "Vaccinations".

[Isgrimnur]

Dallas

The first case of Zika virus has been confirmed in Dallas County, acquired through sexual contact.

Dallas County Health and Human Services received confirmation from the Centers for Disease Control and Prevention.

"The patient was infected with the virus after having sexual contact with an ill individual who returned from a country where Zika virus is present. For medical confidentiality and personal privacy reasons, DCHHS does not provide additional identifying information," the county said in a news release Tuesday. "There are currently no reports of Zika virus being locally-transmitted by mosquitoes in Dallas County. However, imported cases make local spread by mosquitoes possible because the mosquitoes that can transmit the virus are found locally. DCHHS advises recent travelers with Zika virus symptoms as well as individuals diagnosed with Zika virus protect themselves from further mosquito bites."

[Jeff V]

So it's an STD too?

[Smoove_B]

Wow. Between this and Ebola...not a good year for semen.

[Isgrimnur]

I knew you'd love this development.

[Smoove_B]

It could certainly help explain why the disease is rapidly moving through the Western hemisphere, that's for sure. Trying to get up to speed on a disease that was pretty much an afterthought as undergrad education is not something I ever expected. As usual, I'm both amazed and horrified at the same time. Unfortunately it also complicates the message as now we not only need to focus on mosquito control but sexual heath education. It would be nice if mother nature could just pick a transmission route and stick with it. Crafting a disease that can potentially spread via mosquito and sex? That's really stacking the deck against humans.

[Isgrimnur]

If this planet was created specifically for us, someone has some explaining to do.

[Jeff V]

If this planet was created specifically for us, someone has some explaining to do.

Facebook told me just yesterday that whenever He does something dickish, it's because He works in mysterious ways.

[LordMortis]

If this planet was created specifically for us, someone has some explaining to do.

Clearly She wants you to stop having premarital sex with multiple partners and clean up your damned lawn, so there's no sitting water.

[Smoove_B]

Clearly She wants you to stop having premarital sex with multiple partners and clean up your damned lawn, so there's no sitting water.

Well, the first scientific paper examining the possibility of sexual transmission happened between husband and wife, so maybe the message is being lost? From that 2011 article:

What's still unclear is how important sexual transmission is in Zika's epidemiology. Haddow believes it plays a very minor role at best and that the vast majority of cases occur through mosquito bites. Yet a few data points from the Yap outbreak hint that sexual transmission may have played a role, Foy says. The population aged between 30 and 59 was hardest hit, and among women, the so-called attack rate—the percentage of people who get sick—was almost 50% higher than among men. (With most sexually transmitted infections, vaginal intercourse poses a higher risk of infection for women.) But there could be other explanations for that as well; Foy says he's interested in studying the issue.

Similar to Ebola, I have feeling we're going to learn more about Zika in the next 12 months than we thought we knew over the last 50 years.

[LordMortis]

Well, the first scientific paper examining the possibility of sexual transmission happened between husband and wife, so maybe the message is being lost? From that 2011 article:

Well, yeah but She's working through science. The message is still the same. And how was the yard s/he first bit by a mosquito in, hmm?

[Ralph-Wiggum]

How can one tell when a virus is passed through sexual contact rather than other means of infection? Are they just assuming that there are no mosquitoes with the virus in Dallas or are there definitive markers of sexual vs. non-sexual transmission?

[Smoove_B]

Well if Person A travels to a country where the virus is present, they're bit by a mosquito with the virus and they return home and have sexy time with Person B who then develops signs and symptoms of illness, the theory would be sexual transmission. I mean, that would be more likely than a mosquito somehow traveling back with Person A and then biting Person B. This all (of course) assumes that the home location doesn't have endemic levels of the virus. I think the core of your question is for places like Brazil how are we going to know how the exposure occurred and what the greater risks are. Well...here comes the science. Honestly, I'd be amazed if the risk was significant, but I guess we'll see. I think the bigger story will be trying to understand what exactly is causing the microcephaly to happen in certain populations. This NYT piece is a good summary of things so far.

[Ralph-Wiggum]

So what you're saying is that there are now specific markers to indicate sexual transmission; it is just the most likely scenario since (as far as we know), mosquitoes in Dallas aren't carrying the virus. But isn't the fear that someone carrying the virus to the US will get bit by a mosquito which will then introduce the virus into the local population of mosquitoes? Presumably it would be more likely for said mosquito to then bite someone close to the original carrier, right?

On a side note, do we have any idea if Zika is transmitted vertically in mosquitoes? If so, you could potentially go from few mosquitoes with the virus to a whole bunch of them very quickly.

[Smoove_B]

Right - I don't know if there's any difference - or at least I haven't seen it reported that there's any difference with respect to transmission (increased risk, different symptoms, etc...). What I also haven't seen is how long the virus remains in semen and whether or not then it would be possible for a mosquito to bite that person and acquire the virus because maybe then it's also circulating in their blood. There's just so much we don't know. It could be like West Nile where the overwhelming majority of people infected have extremely mild symptoms and no idea they've been infected but during a brief window, it would then be possible for an uninfected mosquito to bite them and acquire the virus.

Vertical transmission (from what I've read) doesn't seem likely for mosquito populations. The typical exposure scenario would be uninfected mosquito bites infected person. Then that same mosquito (now infected) bites an uninfected person and disease transmission occurs. It's a numbers game - more mosquitoes more potential for circulating virus. And then if you're not doing strong mosquito control or it's difficult based on climate or harborage, when they overwinter, it reemerges in the spring. Add in the possibility for asymptomatic human carriers and now you have a stable reservoir for the virus to hang out.

EDIT: Ok, NPR has some more details on the sexual transmission and potential viral load circulating in the human body:

Research on a 2013 outbreak in French Polynesia, the largest known, has yielded the most information on which bodily fluids Zika hangs out in, and when.

One study found signs of the virus in the saliva of patients shortly after the onset of symptoms. A small study in New Caledonia detected it in patients' urine more than 10 days after their first symptoms, and more than a week after it became undetectable in blood.

A third study found the virus in the breast milk of infected mothers, and concluded that two babies who tested positive for Zika virus within days of birth possibly acquired it from their mothers' bodily fluids during pregnancy or birth.

Tesh says it's unclear how the virus remains in bodily fluids, but hypothesizes that the virus could hide in white blood cells.

I still think the lesson here is that if there's blood in your semen...go to the doctor. That just seems like a general bit of good advice regardless.

[Isgrimnur]

WaPo

The Obama administration will ask Congress for $1.8 billion to respond to the Zika virus abroad and prepare for it at home, officials said Monday.
...
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he did not expect a major outbreak in the United States, noting that similar viruses such as dengue fever have been controlled in certain regions of the country such as Texas and Florida. But he said: "We never assume the least. We always assume the worst."

The Centers for Disease Control and Prevention money would be used to reduce transmission in the most vulnerable parts of the United States, including Puerto Rico, Hawaii and southern states such as Florida and Texas. Officials are also focusing on pregnant women and their babies, the groups at highest risk.
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Puerto Rico, the U.S. Virgin Islands and American Samoa are likely to have widespread transmission of Zika because they are home to large populations of the mosquito species considered the primary “vector” for spreading the virus.
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The bulk of the money the administration is requesting, $828 million, would go to the Centers for Disease Control and Prevention. The request also includes $250 million for a one-year increase in Medicaid funds for Puerto Rico. The administration would pump $200 million into accelerated vaccine and testing techniques for Zika through the National Institutes of Health and the Food and Drug Administration. And $210 million would go to a new fund to respond to new outbreaks if they appear in the United States.
...
Fauci said the NIH was already diverting researchers' attention away from projects aimed at similar viruses to draw up ideas on the Zika virus. And he said that if Congress did not appropriate the money, the NIH would be forced to divert money from other projects.

But Fauci and White House spokesman Josh Earnest did not, when asked, offer travel advice to Olympic athletes planning to compete in the games in Brazil this summer. "It’s very difficult to give advice to people who’ve devoted the last number of years training for that," he said. Earnest later added, "Ask your doctor, not the White House press secretary."

[Isgrimnur]

Ohio

Public health officials from the states of Indiana and Ohio reported the first cases of the Zika virus Tuesday morning.

The Ohio Department of Health announced a 30-year-old Cleveland woman who recently returned from Haiti tested positive for the virus, which is primarily transmitted through mosquito bites.
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The Indiana State Department of Health announced that a resident also returning from Haiti tested positive for Zika.
...
The primary mosquito that transmits Zika virus is found in the tropics and southern U.S., but it is not established in Ohio, according to the release from the ODH. Another type of mosquito found in Ohio may potentially transmit Zika virus, although it has not yet been implicated in the transmission of human cases.

[Jeff V]

Holy crap, the mosquitoes are winterized?

[Isgrimnur]

Ohio has 59 types of mosquitoes. Canada has mosquitoes. Winter will not protect you. They are non-migratory.

[naednek]

The olympics in Brazil are gonna be fun this year

[Jeff V]

Ohio has 59 types of mosquitoes. Canada has mosquitoes. Winter will not protect you. They are non-migratory.

They rarely feast on people during this time of year, however. The number of bugs seen outdoors between December 1 and March 1 in these latitudes is approximately zero.

[Smoove_B]

They rarely feast on people during this time of year, however. The number of bugs seen outdoors between December 1 and March 1 in these latitudes is approximately zero.

Which is why bedbugs are able to slowly drain you over the winter and you're none the wiser. They don't really take all that much blood either - from what I understand, the psychological trauma from bedbugs is likely much worse than what they're actually doing to you while you're sleeping. And at least the hookworms from a cat or dog eventually just die. You don't have any fish, do you?

[J.D.]

Wtf, man.

[Jeff V]

You don't have any fish, do you?

I have a Filipino wife. Any fish coming into the house go right into the soup pot.

[Isgrimnur]

Catholic Church

Pregnant women exposed to the Zika virus and who may be carrying foetuses with serious brain defects should not be permitted to have abortions, the Vatican has said.

The Catholic church restated its opposition to abortion in all circumstances as women in South America are frantically trying to terminate pregnancies for fear of giving birth to babies with microcephaly, which gives them unusually small heads.

“Not only is increased access to abortion and abortifacients [abortion-inducing drugs] an illegitimate response to this crisis, but since it terminates the life of a child it is fundamentally not preventative,” the Vatican said.
...
Abortion is banned or highly restricted in many countries affected by the Zika crisis. Earlier this month, the Catholic church in Brazil – one of the worst affected countries – said it strongly opposed a move to permit abortions for pregnant women exposed to the Zika virus. “There is no justification to defend abortion,” it said.

[Isgrimnur]

CNN

During the wide-ranging press conference, [Pope] Francis also seemed to suggest that contraception may be used to prevent the transmission of the Zika virus and praised Saint John Paul II's "holy friendship" with a Polish woman.

[Smoove_B]

Testicles are very friendly hosts for some viruses:

Many scientists think this has to do with the fact that the immune system is actually weaker in the testes, allowing viruses to thrive here. This makes sense from an evolutionary perspective. The testes are so important to our survival that they need an extra layer of protection from attacks by the immune system.

[Odin]

Oh yeah - sweaty, hairy, and swarming with disease. It's amazing our species manages to reproduce at all.

[Biyobi]

Oh yeah - sweaty, hairy, and swarming with disease. It's amazing our species manages to reproduce at all.

Agent Smith confirmed human beings are a disease, so we fit right in.

[AWS260]

The San Francisco Chronicle ran a great story on what it's like to be an older HIV-positive gay man who survived the terrible years before treatment was available. They're the lucky ones, but there's a lot of emotional and financial wreckage.

More than 30 years ago, when he learned he was infected with the virus that causes AIDS, Peter was certain his life was over. Since then, he’d lost not just his lover and his friends, but his livelihood, his community, his home.

But on this Christmas Eve, on the cusp of another new year, Peter was still here: 61, his beard flecked with gray, his eyes still a striking, youthful blue. A survivor of a plague that killed tens of thousands just like him.

“I’m the luckiest unlucky person in the world,” he often said. “No one wants to be the last man standing.”