[Health] The Infectious Diseases Thread

[stessier]

Indeed. Check the map.

What's up with Madagascar? I was promised friendly lemurs, not the plague!

[Smoove_B]

I'm not sure but I now have another place to skip.

EDIT: Interesting story here. Spoiler - they used contact tracing. Remember that?

[Isgrimnur]

https://www.smbc-comics.com/comic/snow-white-3

[Blackhawk]

And a Raiders of the Lost Ark of melting noses.

[Smoove_B]

Everything old is new again. Bonus: Florida

Rising evidence is pointing to the possibility that leprosy has become endemic in the southeastern U.S. with Florida being named among the top reported states.

In a recently published research letter regarding emerging infectious diseases, the Centers for Disease Control and Prevention (CDC) said that Florida is witnessing an increase in leprosy cases lacking traditional risk factors and recommending that travel to Florida be considered when conducting leprosy contact tracing in any state.

Details:

The number of reported leprosy cases across the country has doubled over the past decade, according to the CDC. Citing data from the National Hansen’s Disease Program, the CDC says there were 159 new cases reported in the U.S. in 2020. Nearly 70% of these new cases were reported in Florida, California, Louisiana, Hawaii, New York and Texas.

Florida stands out in the report for two reasons: Central Florida alone accounted for nearly 20% of the total number of cases reported nationally and several new-case patients in central Florida demonstrated no clear evidence of zoonotic exposure or traditionally known risk factors.

Some history:

Hansen’s disease has never been common in the U.S., with most cases previously involving people who immigrated from leprosy-endemic areas. But the new report shows that about 34% of the reported cases between 2015 and 2020 were locally acquired.

The report concludes that a growing body of evidence suggests central Florida may represent an endemic location for leprosy and recommends that physicians consider leprosy in the appropriate clinical context in patients who have traveled to the area, even in the absence of other risk factors.

The CDC hopes that local physicians can help identify and reduce the spread of the disease through their efforts to report cases and their support in further research to assess routes of transmission.

[Daehawk]

Im sure Ron has it handled. By now he has told everyone its just scabs and will be fine. And they have believed him. So it will sort itself out eventually.

[Isgrimnur]

[em2nought]

Im sure Ron has it handled. By now he has told everyone its just scabs and will be fine. And they have believed him. So it will sort itself out eventually.

Sounds more like something that got imported.

[Smoove_B]

Good news everyone! The 2023/23 Influenza vaccination recommendations are out from the CDC!!! I know you were all waiting. No surprises, but they have made one significant change:

There is a change in recommendations for flu vaccines this year and it has to do with people with egg allergies.

Most flu vaccines are produced using eggs and end up containing small amounts of egg proteins. In the past, flu vaccines were recommended for people with egg allergies as long as “additional safety measures” were in place, particularly for those who could experience a severe reaction.

Those extra measures are no longer needed, the CDC said. Now, people with egg allergies can receive any flu vaccine – egg-based on non-egg based – that is appropriate for their age and health status with no special safety precautions needed beyond those that would be taken for any vaccine. People with questions about the vaccine should consult with their healthcare provider.

I've heard all kinds of excuses as to why people didn't (or won't) get a flu shot, but in truth never someone with egg allergies. If this applies to you, congrats.

Generally:

Recommendations for when you should get your flu vaccine remain the same — September and October are still considered the optimal times. August vaccinations aren’t recommended unless someone is in their third trimester of pregnancy or for children who will need two doses of the vaccine or those who will be unable to get vaccinated later in the fall.

Current guidelines call for annual flu vaccinations for everyone 6 months of age and older. How effective the vaccines are each year depends on how well they match the circulating virus, the CDC said. Preliminary estimates show last season people who were vaccinated against the flu were 40%-70% less likely to be hospitalized because of flu-related illnesses.

[Max Peck]

Did something change with the vaccines, or did they just decide that there is not a significant risk after all?

[Smoove_B]

I'm guessing it's 20+ years of mass vaccination experience suggesting risk is low, but I'd need to confirm.

[gilraen]

I've heard all kinds of excuses as to why people didn't (or won't) get a flu shot, but in truth never someone with egg allergies. If this applies to you, congrats.

It's definitely been one of the questions on the flu consent questionnaire. In the recent years, they would offer you Flublok (I think?) if you indicated you had an egg allergy.

[Smoove_B]

Oh yeah, as someone that screens people during clinics, we always ask. But in the hundreds (thousands?) of people I've asked, I cannot think of a single time where "egg allergy" was invoked. Every other excuse, but not eggs.

[ImLawBoy]

My wife has an egg allergy, but it's pretty mild. She's never skipped vaccines because of it.

[Smoove_B]

I'm stretching the point of this thread, but where else am I going to share brain worms?

The patient, a 64-year-old woman from south-eastern New South Wales, was first admitted to her local hospital in late January 2021 after suffering three weeks of abdominal pain and diarrhoea, followed by a constant dry cough, fever and night sweats.

By 2022, her symptoms also included forgetfulness and depression, prompting a referral to Canberra hospital. An MRI scan of her brain revealed abnormalities requiring surgery.

“But the neurosurgeon certainly didn’t go in there thinking they would find a wriggling worm,” Senanayake said. “Neurosurgeons regularly deal with infections in the brain, but this was a once-in-a-career finding. No one was expecting to find that.”

What happened?

Ophidascaris robertsi is a roundworm usually found in pythons. The Canberra hospital patient marks the world-first case of the parasite being found in humans.

The patient resides near a lake area inhabited by carpet pythons. Despite no direct snake contact, she often collected native grasses, including warrigal greens, from around the lake to use in cooking, Senanayake said.

The doctors and scientists involved in her case hypothesise that a python may have shed the parasite via its faeces into the grass. They believe the patient was probably infected with the parasite directly from touching the native grass or after eating the greens.

Congrats on being a world's first!

[Isgrimnur]

Always rinse your vegetables.

[Smoove_B]

Kinda weird, but still not great to read:

Colorado is experiencing the worst West Nile virus outbreak in the U.S. this summer so far. And it’s been one of the deadliest West Nile virus seasons in Colorado since the mosquito-borne illness arrived in the U.S. back in 1999.

As of Sept. 1, 2023, 11 people have died in Colorado this year, and scores of others have needed to be hospitalized.

Why is it so bad?

Colorado has had a wet spring and summer.

...

Other states from California to Texas to Wyoming and the Dakotas are also experiencing West Nile virus outbreaks this summer, but data from the U.S. Centers for Disease Control and Prevention (CDC) show that Colorado so far is experiencing the worst West Nile virus outbreak in the U.S. this year.

...

Colorado has had bad years for West Nile virus over the last two years. Last year, there were 20 deaths and in 2021, there were 11 deaths, according to the Colorado Department of Public Health and Environment.

The worst year on record in Colorado was soon after West Nile virus arrived in the state. In 2003, 66 people died after becoming infected with the virus.

Not familiar with mosquito control programs in CO, but it wouldn't surprise me to learn there have been cuts/downward trends in spending for them over the last decade. Call it a hunch.

Advice for anyone (but especially lOOcals):

Here are some ideas for staying safe:

If you’re spending time outdoors, consider wearing long sleeves and long pants, so it’s not easy for mosquitos to bite you.
Use highly effective insect repellant, preferably a type containing DEET.

[LawBeefaroni]

Wait until this info gets discovered and misused:

Researchers at the University of California, Davis and Colorado State University have found evidence that adding ivermectin to backyard bird feeders has potential to reduce local transmission of West Nile virus in the U.S.

....

“We found that widespread use of ivermectin in backyard bird feeders could reduce neighborhood transmission of West Nile virus by about 60%,” said lead author Karen Holcomb, at UC Davis School of Veterinary Medicine. “That’s because a low dose of ivermectin is harmless for birds, but it gets in their blood and can be lethal for mosquitoes that feed on them.”

https://cvmbs.source.colostate.edu/stud ... bird-feed/

[Punisher]

Wait until this info gets discovered and misused:

Researchers at the University of California, Davis and Colorado State University have found evidence that adding ivermectin to backyard bird feeders has potential to reduce local transmission of West Nile virus in the U.S.

....

“We found that widespread use of ivermectin in backyard bird feeders could reduce neighborhood transmission of West Nile virus by about 60%,” said lead author Karen Holcomb, at UC Davis School of Veterinary Medicine. “That’s because a low dose of ivermectin is harmless for birds, but it gets in their blood and can be lethal for mosquitoes that feed on them.”

https://cvmbs.source.colostate.edu/stud ... bird-feed/

So what you're saying is that if I inject enough of that in me I become death to mosquitoes?
Or should I put it on the bird feeders then eat the birds?
Or should we just catch all the mosquitoes and inject them directly?
Very confusing.

[Blackhawk]

But does it cure the birds of COVID?

[The Meal]

Kinda weird, but still not great to read...
Advice for anyone (but especially lOOcals):

Thanks for thinking of us. One of our poker group lost his father to West Nile in that 2003 barrage. I've long been minimizing time outdoors while sweaty and not in long sleeves.

[Victoria Raverna]

Wait until this info gets discovered and misused:

Researchers at the University of California, Davis and Colorado State University have found evidence that adding ivermectin to backyard bird feeders has potential to reduce local transmission of West Nile virus in the U.S.

....

“We found that widespread use of ivermectin in backyard bird feeders could reduce neighborhood transmission of West Nile virus by about 60%,” said lead author Karen Holcomb, at UC Davis School of Veterinary Medicine. “That’s because a low dose of ivermectin is harmless for birds, but it gets in their blood and can be lethal for mosquitoes that feed on them.”

https://cvmbs.source.colostate.edu/stud ... bird-feed/

Good idea to use ivermectin on human then. If enough people take ivermectin, mosquitoes are not going to be a problem.

[Isgrimnur]

Just in time for summer, your annual update on Vibro vulnificus, via Time:

Climate change is warming ocean waters around the globe, which affects what can thrive in various parts of the seas. Now, bacteria that can cause a flesh-eating infection are showing up in waters once too cold to harbor them.

A new report published in the Annals of Internal Medicine links five recent cases of Vibrio vulnificus to the Delaware Bay, bordered by New Jersey and Delaware. These bacteria live in brackish water—a mix of salty and fresh, often where a river meets a sea. Historically, in the U.S., V. vulnificus have mostly been found in the southeastern part of the country.

A Flesh-Eating Bacterium Is Creeping North as Oceans Warm

[M]any marine biologists are worried about a much smaller—in fact, microscopic—threat. They are tracking an unprecedented surge in ocean-going bacteria known as Vibrio, which recently killed three people and sickened a fourth in Connecticut and New York, at least two of them after swimming in the coastal waters of Long Island Sound.
...
Already, the Centers for Disease Control and Prevention estimates that there may be 80,000 illnesses and 100 deaths caused by Vibrio species in the US each year; about 52,000 of them come from eating seafood. But because shellfish safety is tightly policed by federal agencies, it’s the other portion of Vibrio infections, caused by the species Vibrio vulnificus, that is raising so much concern right now. These infections happen when bacteria-laden seawater infiltrates a break in the skin. In an average year there are believed to be 28,000 cases, but that’s widely considered an undercount.
...
Up to one-fifth of those who contract vibriosis from wound infections die.

[Max Peck]

But because shellfish safety is tightly policed by federal agencies

I think we just identified the next GOP personal freedom plank.

[Isgrimnur]

But because shellfish safety is tightly policed by federal agencies

I think we just identified the next GOP personal freedom plank.

Raw milk didn't take off like it was supposed to.

[Smoove_B]

Two things.

First, the federal government doesn't have nearly as much power over shellfish as you'd imagine. Yes, they're inspecting imports, but only a fraction. Shellfish monitoring comes down to (1) industry self-policing and (2) local health agencies monitoring.

Smoove_B actively avoids shellfish, for those keeping track. It's on the short list of things I just won't eat.

And second, raw milk is absolutely taking off. I guess maybe I'll concede it's not happening as fast as supporters would like, but JFC already with the raw milk agenda.

[Isgrimnur]

[LawBeefaroni]

Just in tune to all go inside and watch football together!

CNN
—
The US Centers for Disease Control and Prevention is warning physicians that cases of respiratory syncytial virus, known as RSV, are rising in the Southeast — and that regional increase may portend a rise in the rest of the United States in the next two to three months.

“Historically, such regional increases have predicted the beginning of RSV season nationally, with increased RSV activity spreading north and west over the following 2–3 months,” according to the CDC Health Alert Network advisory. The notices are communications to physicians and other health care providers across the United States.

[Smoove_B]

Good news everyone! We no longer need to worry about viruses jumping from wildlife to humans. I mean, why else would they just completely dismantle a program helping to monitor for that?

USAID launched the program, known as the Discovery & Exploration of Emerging Pathogens – Viral Zoonoses (DEEP VZN), in October 2021. It tapped the Paul G. Allen School for Global Health at Washington State University (WSU) to lead a consortium that planned to work in up to 12 foreign countries over 5 years. Goals included training people in those countries to safely collect and characterize viruses found in animals, and to identify and develop strategies to thwart pathogens that might gain the capacity to jump to humans and spark a global pandemic.

In late July, however, USAID officials notified WSU investigators that they had canceled DEEP VZN (pronounced “deep vision”), as first reported yesterday by The BMJ. “This decision is in no way a reflection on the performance or capability of the prime partner, Washington State University, or its consortium of partners,” a spokesperson for USAID told ScienceInsider.

[Smoove_B]

Please stop eating raw shellfish - I'm begging you.

A man is dead after contracting a bacterial infection from consuming raw oysters at a local restaurant in Galveston, Texas, public health officials confirmed.

The unnamed man, believed to be in his 30s to 40s, fell ill after consuming raw oysters at a restaurant on August 29, according to Local Health Authority Dr. Philip Keiser. He was admitted to the hospital on September 1 and died three days later.

Officials have attributed his death to Vibrio vulnificus, a bacteria prevalent in warm, coastal waters, which can infect individuals when they consume raw or undercooked shellfish, notably oysters. Additionally, infection can occur through contact with an open wound.

[stessier]

Smoove alert!

A state in southern India is taking measures to contain an outbreak of the Nipah virus after two people died from the rare and often deadly disease, shutting schools and testing hundreds to prevent its spread.

Kerala’s chief minister Pinarayi Vijayan said the virus has been detected in the state’s Kozhikode district, urging residents to exercise caution and follow the health department’s safety guidelines.

Two people have died from the virus, he said in a statement Wednesday, the state’s fourth outbreak since 2018. “We should not be afraid, but face this situation with caution,” Vijayan wrote on social media.

Nipah is a zoonotic virus transmitted from animals to humans, according to the World Health Organization (WHO). However, it can also be transmitted through contaminated food or directly between people.

Infection with the virus can cause mild to severe disease, according to the US Centers for Disease Control and Prevention (CDC). Symptoms often begin with a headache and drowsiness but can quickly transform into a coma within a matter of days, the CDC says.

...

...most human infections resulted from direct contact with sick pigs or their contaminated tissues, according to the WHO. There have been subsequent outbreaks in India and Bangladesh, with more than 600 reported human cases between 1998 and 2015, it added.

Human-to-human transmission of the Nipah virus has also been reported. According to the WHO, between 2001 and 2008, around half of reported cases in Bangladesh were due to human-to-human transmission resulting from workers providing care to infected patients.

[Smoove_B]

In the same viral family as the Measles. Also classified as a potential bioweapon. Definitely something to watch.

Enjoy this article from 2015:

July 4th celebration in Washington, D.C., and across the country, killing more than 6,000 people.

A badly prepared United States does almost nothing at first, and people die as officials scramble to get a grip on what happened.

...

“The nation has not come to fully appreciate the severity of the biological threat and our leaders have not demonstrated the political will to fully address it,” the report says.

Thankfully we know those concerns were overblown.

EDIT: To clarify, I'm not suggesting in any way this was a bioweapon attack, though I'm sure in the coming days certain corners of the internet will be.

[Max Peck]

Since this is the de facto From The Files of Beth Mole thread...

Worm that jumps from rats to slugs to human brains has invaded Southeast US

The dreaded rat lungworm—a parasite with a penchant for rats and slugs that occasionally finds itself rambling and writhing in human brains—has firmly established itself in the Southeast US and will likely continue its rapid invasion, a study published this week suggests.

The study involved small-scale surveillance of dead rats in the Atlanta zoo. Between 2019 and 2022, researchers continually turned up evidence of the worm. In all, the study identified seven out of 33 collected rats (21 percent) with evidence of a rat lungworm infection. The infected animals were spread throughout the study's time frame, all in different months, with one in 2019, three in 2021, and three in 2022, indicating sustained transmission.

Although small, the study "suggests that the zoonotic parasite was introduced to and has become established in a new area of the southeastern United States," the study's authors, led by researchers at the University of Georgia College of Veterinary Medicine, concluded. The study was published Wednesday in the journal Emerging Infectious Diseases.

The finding is concerning given the calamitous infection the rat lungworm, aka Angiostrongylus cantonensis, can cause in humans. The parasitic nematodes are, as their name suggests, typically found in rats. But they have a complicated life cycle, which can be deadly when disrupted.

[Punisher]

I for one welcome our Ilithid overlords.

[Max Peck]

WHO is recommending broad rollout of first malaria vaccination:

The decision, which was announced by WHO Director-General Tedros Adhanom Ghebreyesus, marks a landmark moment in the fight against malaria, for which no other vaccines exist. The disease killed roughly 400,000 people in 2019 — the most recent year for which statistics are available — mostly in sub-Saharan Africa. The biggest toll is on young children; an estimated 279,000 children under the age of 5 died from malaria in 2019.

“As some of you may know, I started my career as a malaria researcher, and I longed for the day that we would have an effective vaccine against this ancient and terrible disease,” Tedros said during a news conference from Geneva. “Today is that day, an historic day.”

He said he believed the vaccine — the first for a human parasite — would save tens of thousands of lives.

This would be an unbelievable development. Mosquitoes are responsible for more deaths each year than anything else on earth.

The first parasitic vaccine if understand correctly. It's a 4 dose vaccine that takes a year to administer and is only 40% effective, but way better than nothing.

New, cheap malaria vaccine backed by WHO

A cheap malaria vaccine that can be produced on a massive scale has been recommended for use by the World Health Organization.

The vaccine has been developed by the University of Oxford and is only the second malaria vaccine to be developed.

Malaria kills mostly babies and infants, and has been one of the biggest scourges on humanity.

There are already agreements in place to manufacture more than 100 million doses a year.

It has taken more than a century of scientific effort to develop effective vaccines against malaria.

The disease is caused by a complex parasite, which is spread by the bite of blood-sucking mosquitoes. It is far more sophisticated than a virus as it hides from our immune system by constantly shape-shifting inside the human body.

That makes it hard to build up immunity naturally through catching malaria, and difficult to develop a vaccine against it.

It is almost two years to the day since the first vaccine - called RTS,S and developed by GSK - was backed by the World Health Organization.

[Isgrimnur]

RTS,S/AS01 vaccine (Mosquirix™): an overview

RTS,S vaccine was created in 1987 as part of a collaboration between GlaxoSmithKline (GSK) and the Walter Reed Army Institute of Research (WRAIR) that began in 1984. At the time, both groups were attempting to develop a vaccine based on proof-of-concept studies that radiation-attenuated sporozoites protected against malaria infection.9 The circumsporozoite protein (CSP) antigen was identified as a target of the immune response generated by radiation-attenuated sporozoites, and was subsequently cloned and sequenced by the U.S. National Institutes of Health (NIH) and WRAIR.10,11 As a full-length CSP antigen proved difficult to produce at the time, the research team used GSK’s Escherichia coli elaboration system to produce a subunit antigen based on the central repeat region, work supported by epitope mapping of protective monoclonal antibodies to this region.12 Among four candidate antigens produced, one advanced to clinical testing in humans with controlled human malaria infection (CHMI), and demonstrated protection in a single volunteer.13 Multiple attempts to advance a standalone CSP subunit vaccine continued, but none showed significant clinical efficacy.14

Using expertise gained during development of the Energix-B™vaccine against Hepatitis B,15 researchers at GSK then pioneered the use of hepatitis B surface antigen as a carrier matrix for the CSP central repeat region, and added the CSP C terminal region that contains T- and B-cell epitopes, all based on the P. falciparum NF54 strain.

[stessier]

Smoove's favorite strikes again - raw milk.

At least 14 people in Utah have been sickened with a serious gastrointestinal infection after drinking "raw," unpasteurized milk, the Salt Lake County Health Department reported this week.

Raw milk outbreaks are not uncommon in Utah, which has some of the more permissive laws regarding the sale and distribution of unpasteurized milk in the country—and an unenviable record of outbreaks. Retail sales of raw milk are legal in Utah and, in 2015, the state passed a law expressly allowing herd-share programs. In these programs people pay for a share of an animal or herd and are thereby entitled to a portion of the unpasteurized milk produced.
In a 2022 study, researchers at the Centers for Disease Control and Prevention found that Utah had the largest number of single-state raw milk outbreaks of any other state between 2012 and 2019. In that timeframe, Utah saw 14 outbreaks. The next-closest state was Pennsylvania, with nine outbreaks.

[Punisher]

Not familiar wirh this so questions.

1. Is all raw milk unsafe?

2. What is it used for that they are selling it at retail?

[Smoove_B]

It is indeed a topic that irritates me. I would love to answer:

1. Is all raw milk unsafe?

All raw milk is inherently riskier to consume because it is unprocessed in any way. You could absolutely drink raw milk and nothing bad would happen, but the chances of you drinking raw milk all the time and not getting sick would be impossible. It is possible to collect and distribute raw milk in a way that lowers some risk, but it would be a small-scale operation. Once these farms start to get interest and begin mass producing product, quality control is stretched and risk of contamination goes up.

2. What is it used for that they are selling it at retail?

There's a belief that raw milk is "healthier" somehow because it isn't pasteurized. That somehow that process reduces nutritional value or health benefits associated with raw consumption. So of course people lobby to have it (and raw milk products like cheese) available at retail locations so they have the freedom to choose.

I suppose if you're an adult and want to take unnecessary risk, raw milk should be an option. However, in the overwhelming majority of these situations, it is parents/guardians that are purchasing this to give to children and of course the illness a child experiences is going to likely be much worse.

And with that, please do enjoy the 2011 story about how the FDA conducted a SWAT raid on a farm in PA over the sale of raw milk across state lines. There are other stories and many that revisited the topic recently, but they really tilt into R&P, because freedom.

[Punisher]

Interesting. I had no idea raw milk was harmful. I just thought store milk was kind of the same.
Good thing i decided on getting that cow from ebay for free milk.