[Health] The Infectious Diseases Thread

[Smoove_B]

Thankfully you live in a state where your local health officials (ahem) are still actively opposing a strong push to make raw milk purchases legal. That said, it won't surprise me if it happens in the next decade, because freedom.

[Punisher]

Thankfully you live in a state where your local health officials (ahem) are still actively opposing a strong push to make raw milk purchases legal. That said, it won't surprise me if it happens in the next decade, because freedom.

While I'm all for freedim, i hope they dont since I'll end up accidentally buying the wring one.

[Z-Corn]

Raw milk is delicious but, yeah, it will eventually make your poop all kinds of weird colors and you will never forget that smell and then you will go on strong antibiotics.

This will happen twice if you are dumb like me.

[Zarathud]

My aunt had a dairy farm that pasteurized on the premises. The glory of their milk was from being richer than whole milk, and it made the best homemade ice cream.

[gilraen]

Thankfully you live in a state where your local health officials (ahem) are still actively opposing a strong push to make raw milk purchases legal. That said, it won't surprise me if it happens in the next decade, because freedom.

At least, unlike airborne pathogens, some idiot ingesting a science experiment in their raw milk will only affect them and not me. If they kill off their kids in the process - well, Darwin approves. At this point I just don't have the energy to care.

[Isgrimnur]

Raw milk is delicious but, yeah, it will eventually make your poop all kinds of weird colors and you will never forget that smell and then you will go on strong antibiotics.

This will happen twice if you are dumb like me.

I didn't know we had a celebrity among us!

[Isgrimnur]

CDC

Raw milk is milk that has not been pasteurized to kill harmful bacteria. Raw milk can carry harmful germs, such as Campylobacter, Cryptosporidium, E. coli, Listeria, Brucella, and Salmonella.
...
People who get sick from raw milk might have many days of diarrhea, stomach cramping, and vomiting. Some people might develop severe or even life-threatening diseases, including:

• Guillain-Barré syndrome, which can cause paralysis, and
• Hemolytic uremic syndrome, which can result in kidney failure, stroke, and even death.

...
Milk can get contaminated in these ways:

Spoiler:

• Germs from an animal’s poop can get in milk
• Germs from an animal’s skin can get in milk
• Germs in the environment (including the barn and milking equipment) can get in milk
• The dairy animal’s udder can be infected (mastitis)
• The dairy animal can have a disease (for example, bovine tuberculosis)
• Insects, rodents, and other small animals can get in milk
• Conditions in the milk processing plant can be unsanitary
• Cross-contamination from dairy workers can happen—for example, through contact with dirty clothing or boots

[Smoove_B]

In not great news, we now potentially have cutaneous leishmaniasis endemic (yes, that's a test) in the United States:

A U.S. Centers for Disease Control and Prevention team has now found nontravelers who were infected with a form of the parasite that is genetically different from those sometimes brought back from overseas, suggesting that cutaneous leishmaniasis is endemic in the U.S. The researchers hope to improve detection of cases across the country by raising awareness that this is no longer a parasitic disease that is only picked up abroad.

During a presentation at the annual meeting of the American Society of Tropical Medicine and Hygiene (ASTMH) on October 19, the researchers described their analysis of 2,133 tissue samples sent to the CDC for testing between 2005 and 2019. In their study, which has not yet been published, they found that most of the positive samples came from people who had traveled to countries where cutaneous leishmaniasis was endemic, but 86 people who were infected had not traveled outside the U.S.

For those unaware:

Cutaneous leishmaniasis is one of the “neglected tropical diseases,” a disparate group of conditions that affect some of the world’s poorest people and receive relatively little global attention. Caused by parasites spread by sand fly bites, the disease is not fatal, but skin lesions, the main symptom, can bring about all sorts of issues relating to depression and stigma. “You get facial scarring for life, which causes all sorts of issues relating to depression and stigma,” says parasitologist David Molyneux of the Liverpool School of Tropical Medicine in England.

...

The news comes amid concern that a more severe form of the disease, called visceral leishmaniasis, could also gain a foothold in the U.S. This disease, which is caused by a related parasite, affects internal organs and kills between 20,000 and 30,000 people per year globally. The worry is that local sand flies could bite dogs that are imported from places where the parasite is common and then bite humans. “We don’t want to put this out as a panic thing; we have no evidence this circulates in the U.S.,” Bausch says. “But there’s evidence it could.” Another presentation at the conference described a risk assessment tool to promote better screening of dogs being imported to the U.S.

Would NOT recommend you do a Google image search.

Of note:

The team found this “American strain” in samples going back 18 years. “Throughout the analysis we conducted, both signatures appear every year,” Cama says. “It seems it’s been there for some time.” Most samples harboring the local strain were from Texas, but this could be partly because of heightened awareness of the disease there. A lack of awareness in other states makes it difficult to know if it is elsewhere. “From a public health perspective, we want to raise awareness among physicians that cases may occur without international travel,” Cama says, “at least in Texas and perhaps other states.”

[Smoove_B]

This is a bit unusual:

Four more people tested positive for tuberculosis in Olathe after a high school student was diagnosed earlier this month, according to the Johnson County Department of Health and Environment.

After the Olathe Northwest High School student tested positive for tuberculosis, health officials identified around 425 contacts to be tested Oct. 12 at the school.

The department identified four more positive cases out of the 273 people who consented to be tested. Those individuals are asymptomatic, and the health department said it will follow up with them.

Why is this unusual?

The department said previously that the risk to the public is low since tuberculosis can only be spread through frequent and prolonged exposure to someone with an active case. Symptoms include a long cough, coughing blood, fever, chills or night sweats.

That active case in the school had to coughing like mad. I hope there's a follow up in the MMWR (I know you are too) that details the other positive students and their association with the index case.

/nerdy thoughts on a Friday

[LordMortis]

I think I must live in the late 19th century.

So in 2010 or so I get whooping cough. Who gets whooping cough? Now I'm diagnosed with TB. I don't go anywhere! I'd say it's got to be a false positive, but I guess there is such a thing as latent TB. This diagnoses is naturally given to me 2 days after my COBRA runs out and Medicaid, while active, won't fully kick in until the state acknowledges my COBRA has run out. I did everything I could to have smooth transition of care with no gap in coverage but the world doesn't work that way. I've been calling the medicaid office every day since 31st and they are surprisingly very prompt and responsive but keep letting me know I have to check back later to get on a plan, get back in my medical system, and have a PCP so I can get referrals.

[gilraen]

How did they diagnose you with TB? Did they run a blood test?

[LordMortis]

How did they diagnose you with TB? Did they run a blood test?

Yes. Blood tests were the last things I got done when I was trying to get all of my transition of care in order, trying to make sure there is no interruption to treatment for my Crohn's. The blood test wasn't even part of my intent on the morning of the 27th but it was something the GI pushed through when I called to try and get advice on choosing a provider within Medicaid that would work best with my existing preferred hospital system and to find a PCP within that system that takes the provider in question. My existing PCP does not take medicaid. I was trying to make things go smooth by preparing ahead of time, but that's not how things are done. I have since been informed that it may be up two weeks before the state and my previous insurance acknowledge the transition and allow me to choose a provider. I can only assume it the coverage will backdate to the first when I got the boot from COBRA but that could be a very costly assume. Fortunately, I feel fine but it's not something I want to screw around with nor expose other people to. I call the state again on Monday.

[Victoria Raverna]

You don't have BCG vaccination in US?

[LordMortis]

I take pretty much whatever vaccine my PCP tells me to. That was never on the table.

[Smoove_B]

It's not a commonly used vaccination in the United States. If you travel or have a history of international travel, it's possible you'd be recommended to get it. But as a routine vaccination for most Americans? Nope. It's not a concern domestically because of (checks notes) aggressive local public health monitoring, contact tracing and treatments.

Ahh...those were the days.

[LordMortis]

It's not a concern domestically because of (checks notes) aggressive local public health monitoring, contact tracing and treatments.

Much like when I got whooping cough and while it was running rampant around here, we collectively shrugged, even as I was down for months. I suppose the signs were here in 2010. That was when I left a big open clinic PCP for a private practice PCP. Now that I'm going on medicaid, I need to remember making sure my new PCP is not part of a big open clinic if I can. Seriously, I often got sick after my annual visits to the doctor and I always got sick after my flu shot (which I discontinued) until I stopped seeing my PCP at a big clinic. After that I only got sick when I was around sick parents at work for prolonged periods. TB is a serious surprise to me.

[Victoria Raverna]

It's not a concern domestically because of (checks notes) aggressive local public health monitoring, contact tracing and treatments.

Much like when I got whooping cough and while it was running rampant around here, we collectively shrugged, even as I was down for months. I suppose the signs were here in 2010. That was when I left a big open clinic PCP for a private practice PCP. Now that I'm going on medicaid, I need to remember making sure my new PCP is not part of a big open clinic if I can. Seriously, I often got sick after my annual visits to the doctor and I always got sick after my flu shot (which I discontinued) until I stopped seeing my PCP at a big clinic. After that I only got sick when I was around sick parents at work for prolonged periods. TB is a serious surprise to me.

I guess contact tracing didn't work if you only found out about the TB accidentally.

[LordMortis]

I guess contact tracing didn't work if you only found out about the TB accidentally.

That and I so far I'm asymptomatic. I have no idea how long I've had this, so I've told the only four people I've spent any length of time indoors that I've tested positive and I'll limit my indoors around other people to grocery shopping and mask wearing until I can see an infectious disease professional. Sadly, that will wait until my insurance coverage settles in. Fortunately for me, I keep a lot of food on hand and I'm pretty well adapted (I hate to say used) to isolation.

[hitbyambulance]

how we doing with Nipah? https://www.reuters.com/investigates/sp ... revention/

[Smoove_B]

This feels like cheating, but coming soon - more diseases:

From the 2019–20 to the 2021–22 school year, national coverage with state-required vaccines among kindergartners declined from 95% to approximately 93%, ranging from 92.7% for diphtheria, tetanus, and acellular pertussis vaccine (DTaP) to 93.1% for polio.

During the 2022–23 school year, coverage remained near 93% for all reported vaccines, ranging from 92.7% for DTaP to 93.1% for measles, mumps, and rubella and polio. The exemption rate increased 0.4 percentage points to 3.0%. Exemptions increased in 41 states, exceeding 5% in 10 states.

NOTE:

More than 5% of kindergarteners have exemptions for at least one vaccine in 10 states—Alaska, Arizona, Hawaii, Idaho, Michigan, Nevada, North Dakota, Oregon, Utah and Wisconsin.

[Blackhawk]

Is this where this goes? It gets confusing.

Now that I have a reliable vehicle for the first time in three or four months, I was able to actually set appointments. I got a threefer today - COVID, flu, and Shingles the First.

I expect to implode by tonight.

[Smoove_B]

On that note, the newest CDC report has flu cases rising in the South Central, South East and West Coast regions of the U.S.

If you have been putting off your annual flu shot, now is the time.

[Blackhawk]

I got a threefer today - COVID, flu, and Shingles the First.

I am now paying the price for this.

Better to just wave off a day and get it done.

[LordMortis]

On that note, the newest CDC report has flu cases rising in the South Central, South East and West Coast regions of the U.S.

If you have been putting off your annual flu shot, now is the time.

Still waiting on my transfer to medicaid (I was rejected from an ACA plan) along side my TB diagnosis so I can follow up with infectious disease specialist. So for most intents and purposes, I'm back on a self imposed COVID lock down. I'll N95 mask up to go grocery shopping now, get stuff in bulk and head back home. That's twice in 12 days. I'm none to worried about getting anything else now. So sick of isolation. I was going to see my first show since 2019 this weekend but that's just unfair to the people I'd be around. My COBRA provider and Aetna are really screwing me on this, taking their sweet time in informing the state, who the require 7-10 days to process the notification. Then I still have to choose a plan and PCP so I can begin the process of seeking treatment. It's a lucky thing I feel no ill effects (yet) and only know I'm infected by a routine screening. Not so lucky, is I am cancelling ongoing care, both due to being insuranceless and to having the mitigating circumstance of having, you know, TB.

[Smoove_B]

To be clear, with latent TB you cannot spread the disease. Your immune system would need to fail and/or something would need to reactivate the "in statis" version of TB you now have, which could potentially cascade into an active TB infection - which you could spread.

That said, protecting your immune system (right now) makes sense.

I thought my person journey on the wheel was strange (and it is) but yours...yours is also strange.

[LordMortis]

Until I see someone, I can't say for sure if my TB is latent or not. I can assume it is. I feel fine, but I am not a medical professional and they have not looked at anything other than screening blood test. Again, it's not fair to the people around me to say "I feel fine, so I don't need to worry about others." My first thought is always, what if someone treated me or my parents this way. The golden rule has always been my compass.

[Smoove_B]

Ah, I misunderstood - I thought you were diagnosed with latent TB. I'd actually be surprised if it wasn't, but I totally get your line of thinking.

In another lifetime I gave you a ride to the hospital for additional testing and treatment. Those were some strange days.

[Kraken]

I got a threefer today - COVID, flu, and Shingles the First.

I am now paying the price for this.

Better to just wave off a day and get it done.

That Shingrex is serious medicine.

[Blackhawk]

I got a threefer today - COVID, flu, and Shingles the First.

I am now paying the price for this.

Better to just wave off a day and get it done.

That Shingrex is serious medicine.

I would say something clever, but Shingrix made my brain floppy!

[em2nought]

I've been putting off my shots until I've got my house on the market. Didn't want them to slow me down as I'm already slow enough as it is.

[Isgrimnur]

ChiTrib

Illinois health officials Monday reported 154 confirmed cases of a rapidly spreading and potentially deadly fungal disease, with a high concentration in the Chicago area.

That total makes Illinois the state with the second-highest number of cases of Candida auris in the nation, behind only New York.

I guess it's not beer-worthy since it's not a Saccharomyces strain.

‘Superbug’ cases rising in Nevada over past two months: health officials

Information obtained by Nexstar’s KLAS from the Nevada Department of Health and Human Services shows Candida auris, or C. auris, has been found at 42 facilities, with Sunrise Hospital and Medical Center in Las Vegas experiencing the highest levels — nearly 500 total cases.

C. auris is a fungus that is easily spread. It is one of five superbugs identified in 2019 by the Centers for Disease Control and Prevention (CDC) as “urgent.” They are so-called “superbugs” because they are hard to kill with existing drugs.

In 2022, the CDC reported there were 2,377 clinical cases and 5,754 screening or colonization cases — where the fungus was present but had not caused an infection — in the U.S. In Nevada alone, there were 384 clinical cases reported, more than any other state (California was close behind at 359).

[Smoove_B]

Feline coronavirus blamed for thousands of cat deaths:

When thousands of cats started to die this year on the Mediterranean island of Cyprus, nicknamed the “island of cats” for its 1-million-strong feline population, the crisis made international news. The animals had fevers, swollen bellies, and lethargy—symptoms that pointed to feline infectious peritonitis (FIP), a common condition caused by a type of cat coronavirus. But scientists struggled to explain the apparent explosion in cases.

Now, researchers have identified a possible culprit: a new strain of feline coronavirus that has coopted key RNA sequences from a highly virulent dog pathogen called pantropic canine coronavirus (pCCoV). The findings, posted as a preprint last week on bioRxiv, could help explain how severe illness managed to spread so widely among cats on the island.

Surprisingly it was just wild genetic recombination and not gain of function work in a laboratory staffed by dogs.

Anyway, it's something to watch and should be reinforcing our concerns over zoonotic illnesses as they bounce around wild and domestic animal species, ultimately potentially jumping to humans.

[Isgrimnur]

You wouldn’t want dogs working in a laboratory until you come up with tail control measures.

[Max Peck]

Surprisingly it was just wild genetic recombination and not gain of function work in a laboratory staffed by Pekingese dogs.

FTFY

[Daehawk]

Life will find a way.

[hitbyambulance]

https://www.kiro7.com/news/local/expert ... FCEBU6F2A/

so... dog covid?

[Smoove_B]

Definitely going to watch that dog situation!

Not good news about measles:

In a joint report today, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) said amid ongoing declines in measles vaccination, cases in 2022 rose by 18%, and deaths were up 43% globally compared to 2021.

...

Measles deaths were highest in low-income countries, where coverage rates were lower, with no sign of recovery after the pandemic. Of 22 million who missed their second measles vaccine dose last year, more than half were from just 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Madagascar, Nigeria, Pakistan, and the Philippines.

In a CDC press release, Kate O'Brien, MD, the WHO's director for immunization, vaccines, and biologicals, said the report's findings are an alarm bell for action. "Measles is called the inequity virus for good reason. It is the disease that will find and attack those who aren’t protected," she said.

Here in the U.S. we're really good about addressing inequity, so this shouldn't be an issue.

/s

[Max Peck]

A while back I had a little rant about why I don't trust generic drugs as a matter of principle.

I believe, from my own experience, that there can also be an issue with quality control. When a generic is being sourced from the compounder who submits the lowest bid, there can be QC issues if they're cutting corners to keep their costs down.

This entry from the files of Beth Mole illustrates the completely foreseeable result of the race to the bottom in order to find the cheapest sources:

Barefoot workers, bacteria found at factory that made big-brand eye drops

The Indian manufacturing facility that made generic eye drops sold under CVS, Target, Rite Aid, and Walmart brands had a slew of manufacturing violations, including allowing workers to regularly perform their roles barefoot and failing to document bacterial contamination, according to an inspection report released by the Food and Drug Administration.

Last month, the regulator warned consumers to immediately stop using over two dozen kinds of big-brand eye drops due to a risk of infection. The list has since been updated to include a few more products. In addition to the big store brands, the eye drops were also sold as Leader (Cardinal Health), Rugby (Cardinal Health), and Velocity Pharma branded products.

All of the products are made by Kilitch Healthcare India Limited in Mumbai. At the time of the FDA's initial warning, the agency said it had found bacterial contamination in critical production areas of the Mumbai facility. As such, the agency warned of a possibility that the products, which are intended to be sterile, may not be and could pose a risk of infection.

To date, no infections have been linked to any of the eye drops. But the big retailers quickly began pulling the products from shelves upon the FDA's warning. This week, Kilitch issued a voluntary recall of the products.

The inspection report, recently released, offers more details of the FDA's alarming findings. Inspectors, who surveyed the facility between October 12 and 20, found 14 categories of manufacturing problems. They included problems with documentation, laboratory controls, data reporting, sanitation, testing, and monitoring.

FDA inspectors found the facility was in poor condition generally, noting cracked floors, peeling paint, water stains, and dust build-up. Most surprisingly, the inspectors observed barefoot employees working in a sterile area of the facility, where they should have been wearing shoes—plus gowns, gloves, and shoe booties. (The barefoot workers were also not wearing gowns or gloves.) A production manager puzzlingly told FDA inspectors that shoeless work is "standard practice."

Inspectors also noticed that if workers at the facility detected bacterial contamination that registered over an "action" or "alert" level, the testing results were not recorded. Instead, the measurement was discarded and the microbiology manager would order more cleaning until the contamination testing fell below the alert level. A microbiologist at the facility said this happened two to three times a month.

The FDA report noted that over the last five years, the facility's microbiology laboratory reported no action-level results and only four alert-level results from environmental monitoring and personnel monitoring. But, when samples were collected during the FDA's inspection—and only between October 16 and 18—there were 39 alert- and action-level detections. Of those, 33 were action-level results.

[GreenGoo]

Received my letter from health plan outlining only generics going forward. Should be fun.
So far I've received brand name, so I'm waiting for the other shoe to drop.

[Max Peck]

Received my letter from health plan outlining only generics going forward. Should be fun.
So far I've received brand name, so I'm waiting for the other shoe to drop.

Yeah, I got the same letter. I'm not going to fight them on it, but I'm not going to switch to a generic either. I'm already getting a rebate through Innovicares, so I'll live with that plus whatever the generic-equivalent rate turns out to be. Paying a dollar a month for my Crestor prescription was nice, but it always seemed too good to last, so I've been expecting the claw-back sooner or later.

If you haven't already done so, it may be worth checking to see if Innovicares or RxHelp covers the drug you're taking and/or is accepted at your pharmacy. Generally, as I understand it, the rebate pretty much brings the price down to what a generic would cost, so I'm hoping the price jump for my prescription won't be all that egregious. When PSHCP was fully covering the prescription, that coupled with the rebate was making it virtually free -- less than $3 for a 90-day refill.