Ebola in Uganda

Lots of bad reporting and misinformation on this latest Ebola outbreak in Africa. From CNN today:

Teams in Uganda are trying to track down anyone who came into contact with patients infected with the Ebola virus, which has killed at least 14 people there this month, authorities said Monday.

The Ebola virus is a highly infectious, often fatal agent spread through direct contact with bodily fluids. Symptoms can include fever, vomiting, diarrhea, abdominal pain, headache, a measles-like rash, red eyes and, at times, bleeding from body openings.

Highly infectious?

Or from the Ugandan President in this BBC report:

Uganda's President Yoweri Museveni has urged people to avoid physical contact, after the deadly Ebola virus claimed one life in the capital, Kampala.

People should avoid shaking hands, kissing or having sex to prevent the disease from spreading, he added.

Really? Shaking hands?

Why polio hasn't gone away yet

Polio was on the CNN home page yesterday with an article entitled Why polio hasn't gone away yet.

The World Health Organization has an action plan for the next 18 months that could very well lead to eradication, says Oliver Rosenbauer, spokesman for polio efforts at the organization.

But there's a $945 million funding gap, he said. Already, polio immunization activities in 24 countries have been cut this year.

And then there are logistical issues of getting vaccines to the children who need them most.
There's an Opinion piece too by Dr. Muhammad Ali Pate and Dr. Christopher Elias: Don't fall at the finish line in the race to eradicate polio. Dr. Pate is Minister of State for Health in Nigeria and Dr. Elias is president of Global Development at the Bill & Melinda Gates Foundation.

As public health practitioners and as parents, we believe that every child, no matter whether they were born in a U.S. hospital or a hut in Nigeria, deserve to be protected from this preventable disease. And we believe that because eradicating polio is something that benefits us all, we all share in the responsibility to make that happen.

She speaks for me

The world's largest AIDS conference (22,000 people) met in the United States for the first time in 22 years this week after President Obama lifted travel restriction on HIV positive people allowing the conference to be held here. However travel bans were still in place on foreign sex workers, under laws passed two centuries ago. This led to several disruptions at the conference as protesters brought attention to the absence of one of the key groups in stopping the epidemic.

Barbara Lee ( U.S. Representative for California's 9th congressional district - most famous for being the only member of either house of Congress to vote against the authorization of use of force following the September 11 attacks) was instrumental in getting the travel ban on HIV patients lifted and last week introduced a proposed law in the House of Representatives to do the same for sex workers.

"I don't know how we're going to ever see an end to AIDS in our lifetime -- and we believe we can, especially with scientific advances -- and have an AIDS-free generation, without including all of those populations who must be involved as part of this solution." U.S. Rep. Barbara Lee of California.

MRSA day

On Tuesday it was announced that October 2nd will be the Fourth Annual World MRSA Day(and October is  World MRSA Awareness Month)  and the theme this year is 'The MRSA Epidemic – A Call to Action'.

This event is organized annually by the MRSA Survivors Network and there's a lot of useful information at their website.

MRSA Survivors Network was founded in early 2003. MSN was the first consumer organization in the U.S. to raise the alarm concerning the MRSA epidemic and other multi-drug resistant healthcare-acquired infections. MSN has been the key catalyst for change on an international and national front with its groundbreaking crusade and mission to stop MRSA deaths and infections. MSN partners with healthcare professionals, healthcare companies and consumer organizations.

Polio - a miscellany

We didn't have much time to talk about polio but if you'd like to know more here are some polio related items culled from past posts.  

Polio in comic book form 

The story of Polio in comic book form.by James Weldon, a journalism student at the University of British Columbia. Learn the full story from the polio virus itself as it tells all in a group therapy session for 'diseases nearing extinction' with smallpox, guinea worm and leprosy. Lots of little jokes in here and a surprising amount of information. 

Iron Lungs 

When people are nostalgic for the 'simpler' times of the 1950's (after the war but before the turbulence of the sixties) they usually conveniently forget about horrors such as polio and iron lungs. These days many people probably only think of an iron lung as a Radiohead song, and even then many people miss the metaphor - something that keeps you alive but becomes very restrictive.

I am amazed by people who have lived their whole lives in them but have remained cheerful and happy. As well as the story about John Prestwich there is also the story of Martha Mason who has lived in an iron lung for over 60 years.

(A)s one of the few surviving people left who live their lives encased in an iron tank, she said she intends to continue as she always has -- making the most out of what life has offered her. 
"Get as much joy from life for yourself and others as you can squeeze out of it," she said. 

Polio eradication - is it worth it?

Check out this New York Times article about Polio eradication that contains some interesting comments about Bill Gates funding for the initiative in particular:

The effort has now cost $9 billion, and each year consumes another $1 billion. By contrast, the 14-year drive to wipe out smallpox cost only $500 million in today’s dollars. 

“Bill Gates’s obsession with polio is distorting priorities in other ... areas. Global health does not depend on polio eradication.”  

Bin Laden vaccination Ruse

There's a fairly factual report in the New York Times, Vaccination Ruse Used in Pursuit of Bin Laden, but they miss the serious implications of this that are discussed in this post at Wired,File Under WTF: Did the CIA Fake a Vaccination Campaign?

This is awful. It plays, so precisely that it might have been scripted, into the most paranoid conspiracy theories about vaccines: that they are pointless, poisonous, covert shields for nefarious government agendas meant to do children harm.

Etymology of Chicken Pox

It struck me today when I mentioned the origin of the word malaria that I should look up the origins of some more disease names. Some are obvious but some are not. Chicken pox for example. Apparently it is the source of some debate. Wikipedia sums it up:

There are several theories regarding the origin of the term chicken pox. It is often stated to be a modification of chickpeas (based on resemblance of the vesicles to chickpeas), or due to the rash resembling chicken pecks. Other theories include the designation chicken for a child (i.e., literally 'child pox') or a corruption of itching-pox. Samuel Johnson explained the designation as "from its being of no very great danger."

I also found this paper from the Lancet in 1896 which I thought was interesting.

ON THE ORIGIN AND HISTORY OF SOME DISEASE-NAMES.
William Sykes, M.D. DUNELM., F.S.A. (A CORRESPONDENT OF THE NEW ENGLISH DICTIONARY.)
All  disease-names  are only labels  by means of which the  maladies themselves  can be  identified, discriminated, and classified, and those  names are the best which are simple, distinctive, and express no theories of causation. It is the folk names which  most often meet these requirements, and therefore  deserve the widest adoption by us in the future.

MRSA news

The good news is that MRSA rates in hospitals and in the community have declined in a recent survey. The authors suggest that a change in hospital reporting laws may have provoked the decrease.

Trends in Invasive Infection with Methicillin-Resistant Staphylococcus aureus,Connecticut, USA, 2001–2010
We examined trends in incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in Connecticut, with emphasis on 2007–2010, after legislation required reporting of hospital infections. A case was defined as isolation of MRSA from normally sterile body sites, classified after medical record review as hospital onset (HO), community onset, health care–associated community onset (HACO), or community-associated (CA). Blood isolates collected during 2005–2010 were typed and categorized as community- or health care–related strains. During 2001–2010, a total of 8,758 cases were reported (58% HACO, 31% HO, and 11% CA), and MRSA incidence decreased (p<0.05) for HACO and HO, but increased for CA. Significant 3- to 4-year period trends were decreases in all MRSA (–18.8%), HACO (–12.8%), HO (–33.2%), and CA (–12.7%) infections during 2007–2010, and an increase in CA infections during 2004–2006. Decreases in health care–related isolates accounted for all reductions. Hospital infections reporting may have catalyzed the decreases. 

Rabid

I don't cover rabies in this course but if you are interested in diseases generally you may want to check out a new book '“Rabid: A Cultural History of the World’s Most Diabolical Virus”. Here's part of a review from the New York Times where they point out what a fabulous example of vaccination success rabies is.

(R)abies vaccinations for dogs, which have always seemed to me a bureaucratic annoyance (who gets bit by rabid dogs these days anyway?), have produced one of the historic successes in public health.

Hardly anyone in developed countries gets rabies now because dogs are routinely vaccinated.

In the rest of the world, however, 55,000 people die each year of rabies. 

And a lurid detail about rabies I didn't know.

(R)abies, on its inexorable death crawl through the nervous system to the brain, can cause sustained erections, and on rare occasions frequent, and uncontrollable ejaculations in human males.

The authors write, “case reports from history describe up to thirty ejaculations in a single day” and go on to note that “The Roman physician Galen, in his own remarks on rabies, describes the case of an unfortunate porter who suffered such emissions for three full days leading up to his death.”

Zombie preparedness

You may remember the Center for Disease Control's tongue-in-cheek guide to surviving a zombie pandemic from last year. I thought it was a good idea, capturing people's interest in an entertaining way and teaching them a little about diseases and, more importantly, disaster preparedness.

Our graphic novel, "Preparedness 101: Zombie Pandemic" demonstrates the importance of being prepared in an entertaining way that people of all ages will enjoy. Readers follow Todd, Julie, and their dog Max as a strange new disease begins spreading, turning ordinary people into zombies. Stick around to the end for a surprising twist that will drive home the importance of being prepared for any emergency. Included in the novel is a Preparedness Checklist so that readers can get their family, workplace, or school ready before disaster strikes. Click on the image below to view the novella. A transcript can be found by clicking on the “accessible text” PDF. You can also download the novella on Google books here or download a printable pdf versions here.

They got lots of press for it and it seemed to be received well. Unfortunately they decided to follow up with the CDC's guide to surviving your wedding day. Worst. Sequel. Ever.

A cure for Ebola (in monkeys...)

In Science Translational Medicine this week:

Successful Treatment of Ebola Virus–Infected Cynomolgus Macaques with Monoclonal Antibodies

Ebola virus (EBOV) is considered one of the most aggressive infectious agents and is capable of causing death in humans and nonhuman primates (NHPs) within days of exposure. Recent strategies have succeeded in preventing acquisition of infection in NHPs after treatment; however, these strategies are only successful when administered before or minutes after infection. The present work shows that a combination of three neutralizing monoclonal antibodies (mAbs) directed against the Ebola envelope glycoprotein (GP) resulted in complete survival (four of four cynomolgus macaques) with no apparent side effects when three doses were administered 3 days apart beginning at 24 hours after a lethal challenge with EBOV. The same treatment initiated 48 hours after lethal challenge with EBOV resulted in two of four cynomolgus macaques fully recovering.


There's a news report on this paper here: Did Scientists Just Discover a Cure for Ebola?

AIDS campaigns

Two very different approaches.

 
 

Viral Chatter

Virus hunter Nathan Wolfe is outwitting the next pandemic by staying two steps ahead: discovering deadly new viruses where they first emerge -- passing from animals to humans among poor subsistence hunters in Africa -- before they claim millions of lives.

Check out Nathan Wolfe's talk at the 2009 TED conference. TED (Technology, Entertainment, Design) invite some of the world's most fascinating thinkers and doers, and challenge them to give the talk of their lives. The best talks and performances are available on their website. You should all check out this talk, it is very interesting, very well presented and hugely relevant to this class.

There's also a New Yorker article from 2010 that covers Nathan Wolfe's work:

Sandrine had just finished preparing the meat for dinner. I asked her if she understood how risky it was to plunge her hands into the intestines of a dead monkey. “Yes,” she said. “I know that bushmeat is dangerous. That it can kill my children.” She was also aware that there had been an outbreak of Ebola recently in Congo. I wondered whether she or her husband had ever seen dead monkeys or gorillas in the forest. She nodded, gazing at the dark foliage as night began to fall. “What did you do when you saw them?” I asked. She turned to me and smiled. “I thanked God, picked them up, and brought them home for dinner,” she said.

History of AIDS

The Washington Post has a photographic history of the AIDS epidemic in the United States to mark the three decades that have passed since Robert Gallo and Luc Montagnier identified HIV as the virus that causes AIDS in 1983. It's a poignant reminder of how much this epidemic has affected our society.


Many of the iconic images of the US AIDS epidemic are there but the classic photograph above was missing. It didn't take long to find it though, at CNN: The photo that brought AIDS home.

Pluggers

I don't really understand this comic strip. But then again I'm not the only one. From the Comics Curmudgeon:

It’s funny because pluggers aren’t qualified for any job important enough to require a background check! Also, they are covered with ticks. Rule of thumb: if your Pluggers strip reminds the reader too forcefully that its main characters are hirsute, vermin-ridden beast-men, it has gone off the rails a bit.

Ecology of Disease

The New York Times has a great little article tomorrow titled 'The Ecology of Disease'. A good review of last week's topics and a nice piece of science writing.

And Lyme disease, the East Coast scourge, is very much a product of human changes to the environment: the reduction and fragmentation of large contiguous forests. Development chased off predators — wolves, foxes, owls and hawks. That has resulted in a fivefold increase in white-footed mice, which are great “reservoirs” for the Lyme bacteria, probably because they have poor immune systems. And they are terrible groomers. When possums or gray squirrels groom, they remove 90 percent of the larval ticks that spread the disease, while mice kill just half. “So mice are producing huge numbers of infected nymphs,” says the Lyme disease researcher Richard Ostfeld.

Xenophobia and disease

An interesting post at the Scientific American blog about the relationship between xenophobia and disease.
Do Wild Bats Hold the Key to Understanding Human Tribal Behavior?

(A) new fungus has arrived in North America, most likely via introduction by humans, and it is killing bats. This fungus (Geomyces destructans) causes “white nose syndrome,” which was first seen in the U.S. in New York in 2006. Where it met the bats, the fungus spread quickly among roosts, killing nearly all of the little brown bats and other bat species in each of the caves in which it appeared. 

But not all is lost. Although it looked as though the little brown bats and several other species might soon face extinction, at least in some regions and perhaps even in North America, the little brown bats have begun to rebound in some places, albeit modestly. A new paper out this week takes notice of one of the reasons they appear to be rebounding, the bats are avoiding each other. Little brown bats (at least historically) tend to roost in large, groups, one next to the other, bumping fuzzies as it were. But not anymore. More and more, this new study, led by Kate Langwig, a graduate student at Boston University, suggests, the bats are spreading themselves out in their roosting caves, their hibernacula. Once, they clumped, warming themselves around the tiny fires of their bodies. Now, they go it alone.

Interestingly, this little brown bat behavior is precisely what the literature on human behavior, xenophobia and tribalism would have predicted. 

Chagas Disease

We don't cover Chagas disease in this class (although I did put a picture of the kissing bug vector on my vector slide) but if you'd like to learn a little about another disease then take a look at this LA Times article: Chagas' disease can cast a silent, lifelong shadow. Chagas is a potentially fatal parasitic disease most often found in Latin Ameri can immigrants. There had been little awareness of it in the U.S., but that's changing.
...
Experts agree that Chagas needs more attention, but a recent editorial in the Public Library of Science's journal Neglected Tropical Diseases sparked controversy by labeling Chagas "the new HIV/AIDS of the Americas." Peter Hotez, the paper's lead author and dean of the National School of Tropical Medicine in Houston, noted that both are chronic diseases spread by blood, require toxic medications and disproportionately affect the poor.

Lyme in the news

The Lyme disease diagram I showed in class was from this Discover article based on Richard Ostfeld's  research. The article doesn't have much detail; the ScienceDaily report has a little more detail.

Lyme disease is big news in the North East and Mid West. Here's a very recent story from the detroit Free Press: Increase in Lyme disease cases might have a coyote connection

This report is based on this paper in PNAS: Deer, predators, and the emergence of Lyme disease.

The emergence of Lyme disease has been attributed to a century-long recovery of deer, an important reproductive host for adult ticks. However, a growing body of evidence suggests that Lyme disease risk may now be more dynamically linked to fluctuations in the abundance of small-mammal hosts that are thought to infect the majority of ticks. The continuing and rapid increase in Lyme disease over the past two decades, long after the recolonization of deer, suggests that other factors, including changes in the ecology of small-mammal hosts may be responsible for the continuing emergence of Lyme disease. We present a theoretical model that illustrates how reductions in small-mammal predators can sharply increase Lyme disease risk.

Simple questions, difficult answers

Lyme disease is, obviously, a much bigger news story in the North East. The New Haven Register recently published a number of articles about the disease and the issues involved. All the articles are fairly short, I'd recommend you read the first one and then any of the other questions that seem interesting.

LYME DISEASE: Simple questions, difficult answers as controversy endures

(M)uch about the corkscrew-shaped microorganism and the ills it causes continue to mystify disease specialists.

Why are some patients easily cured with antibiotics, while others continue to suffer for months or years? Why do some patients experience a mild illness, while others are practically immobilized?

• What is Lyme disease?
• What causes Lyme disease, exactly?
• If the spirochete was not created in a lab, where did it come from and how does it live around here?
• If I find a tick on me, what should I do?
• Can the black-legged tick transmit anything bad other than Lyme disease?
• Why don’t we just eradicate ticks?
• How do I know if I have Lyme disease?
• What’s the harm in giving antibiotics just to be safe?
• Doctors keep saying they have studies. What studies?
• There’s a lot of disagreement about Lyme disease. But why is there so much acrimony?

Or if you'd just rather read about George Clooney's face...

When is a vaccine not a vaccine?

I posted last year about the CIA's use of a fake vaccination campaign in an attempt to verify the identity of Osama bin Laden. A very bizarre story.

In the months before Osama bin Laden was killed, the Central Intelligence Agency ran a phony vaccination program in Abbottabad, Pakistan, as a ruse to obtain DNA evidence from members of Bin Laden’s family thought to be holed up in an expansive compound there, according to an American official. 

One of the oddest parts about this story is that they didn't use the correct vaccination schedule.  They gave inadequate doses of the vaccine, leaving behind kids whose parents thought they were protected from Hepatitis B, but who were, in fact, not.

This year the Taliban have banned a Polio vaccination campaign in Pakistan in protest against both drone strikes and also from fear that the campaign could be used for further CIA espionage activities. Until last year this would have sounded a little paranoid...

Not vaccinated? Not acceptable

To whet your appetite for tomorrow's lecture here is an editorial from the LA times last year

Public health: Not vaccinated? Not acceptable
What should we do about people who decline vaccination for themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases?

What does society do when one person's behavior puts the greater community at risk? We make them stop. We pass laws, or impose economic rules or find some other way to discourage individual behaviors that threaten the greater common good. You don't get to drive drunk. You don't get to smoke in public places. You don't even get to leave your house if you catch some particularly infectious disease.

Then what should we do about people who decline vaccination for themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases? Isn't this the same thing: one person's perception of risk producing behaviors that put others at risk? Of course it is. Isn't it time for society to say we need to regulate the risk created by the fear of vaccines? Yes, it is.

Plague in affluent areas?

With the news that an Oregon man has been hospitalized with suspected  plague has come some news stories about how bubonic plague is now affecting more affluent areas.

Schotthoefer noted that these more affluent areas where plague occurred were regions where new housing developments had been built in habitats that support the wild reservoirs of plague, which include ground squirrels and woodrats.

Whilst this may be true it should be noted that bubonic plague is a VERY rare disease in the United States these days with only about 11 cases a year on average. (For comparison 73 people are killed by lightning each year in the United States).

Still, you might want to be careful about extracting rodents from the mouths of stray cats...

Cambodian mystery

I almost posted this intriguing report of a deadly new disease in Cambodia yesterday, following the WHO press release, but there just didn't seem much information.

Cases of severe respiratory disease with neurological symptoms have been reported to the Ministry. To date, 61 of the 62 children admitted in hospitals have died from the disease.

However that hasn't stopped CNN putting it on their front page. I'll give them credit though, they do put the outbreak in some perspective:

Richner added that the number of cases affected by the unknown disease is low -- 34 cases in June, compared with the 75,000 sick children at Kantha Bopha's outpatient clinics and 16,000 hospitalized kids.

Possibilities include a brand new disease, a combination of known diseases, or some effect of a faulty drug or vaccine. Interesting clues are the age profile, all children so far, and the apparent lack of clustering which suggest something environmental rather than biological.

Infection

Andy sent me this link to a cool BBC news report on using scanning equipment to watch an infection in real time.

The video shows bacteria infecting the small intestine, retreating to a small pocket in the digestive tract and the booming in numbers as they spread to the rectum then all over the large intestine.

The later scans show the immune system driving the bacteria back and the mouse clearing the infection.

Traditional videos

The posting of the following videos has become traditional during the Bubonic Plague section of the course. The first one isn't strictly bubonic plague related, it's just included because of the flagellants. Enjoy your long weekend.

The Daily Show with Jon Stewart	Mon - Thurs 11p / 10c
Bubonic Plague
www.thedailyshow.com
Daily Show Full Episodes Political Humor & Satire Blog The Daily Show on Facebook

Latest 'superbug' - NDM-1

Here's a nice example of how I hope this class can help you understand the science behind the headlines a little better.

If you read the news you may have come across references to the latest 'superbug' NDM-1. But this is misleading, and confusing, because NDM-1 is actually just the name of an enzyme (New Delhi metallo-beta-lactamase-1). Several problematic bacteria have now acquired the ability to manufacture this enzyme (and you now know how they probably acquired this ability - especially if I tell you it is often carried on a plasmid).

Why is this enzyme important? Because it can break down beta-lactam antibiotics called Carbapenems that were developed to be more resistant to the beta-lactamase enzymes that many bacteria now have. Carbepenem antibiotics are extremely powerful and often used to fight highly resistant bacteria when other antibiotics have failed.

Bacteria that can produce NDM-1 are sometimes referred to as superbugs because infections caused by them are difficult to treat but NDM-1 is the name of the enzyme, not a specific bacteria.

For more information see: NDM-1 — A Cause for Worldwide Concern in the New England Journal of Medicine.

TDR or not TDR TB in India

In January this year a strain of TB emerged in India that was incurable and appeared resistant to all antibiotics.
 Scrambling for a name (we already have MDR-TB and XDR-TB for multi-drug resistant and extensively drug resistant TB) the media settled on TDR-TB (totally drug resistant TB)

The Indian government leaped into action and said that the term “totally drug resistant” tuberculosis is “misleading” and has not been endorsed by the World Health Organization. It has classified the cases as extensively drug resistant tuberculosis despite the fact there is good evidence that this strain is more drug resistant than previous  XDR-TB strains.

Arguing about exactly what the strain should be called seems a little like arguing about how on fire your house is. The bottom line is that this is very bad news and the inevitable has happened - in India at least we are back to Sanitoriums.

Wired magazine has covered this story well in their online Superbug blog. eg here: TDR-TB: The Indian Government Denies It and, earlier, here:  India Reports Completely Drug-Resistant TB.