Showing posts with label Disease Control. Show all posts
Showing posts with label Disease Control. Show all posts

Friday, January 31, 2014

CDC Director Frieden: On Preventing A Pandemic

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Photo Credit WHO

 


# 8253

 

Yesterday the CDC’s director Dr. Thomas Frieden held a telebriefing called  U.S. safer when CDC works with other countries to fight infectious diseases, to `discuss improvements in disease detection and response that may serve as a model for fighting infectious disease throughout the world’.


The transcript and audio are now available online, for those who were unable to attend.

 

Central to his presentation were two reports that appeared yesterday in the MMWR.

 

Rapidly Building Global Health Security Capacity — Uganda Demonstration Project, 2013

Strengthening Global Health Security Capacity — Vietnam Demonstration Project, 2013

 

Today, in a follow up, Dr. Frieden has penned a special blog post for CNN, where he discusses the dangers of a pandemic, and the steps that need to be put in place to prevent or mitigate its arrival.

 

08:49 AM ET

How to prevent the next pandemic

By Tom Frieden, Special to CNN

Editor’s note: Dr. Tom Frieden is the director for the Center for Disease Control. The views expressed are his own.

Today marks the Lunar New Year – and the world’s largest annual migration. There will be more than 3.6 billion transit trips within China, in addition to countless international trips. Yet this celebration comes at a time of growing concern about the H7N9 avian influenza virus. And this concern is not unfounded – should this virus change into a form that easily spreads between people, the world’s next pandemic could occur in the next three weeks.

This combination of mass travel and an emerging virus such as this should underscore the connectedness of health security between countries. Of course, H7N9 influenza is just one example of how the health security of all nations, including the United States, depends on the health security of each individual nation. And regardless of where outbreaks occur, stopping them at the source is the most effective and cheapest way to save lives at home and abroad.

(Continue . . . )

Sunday, July 28, 2013

Head ‘Em Off At The Passenger Gate?

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Scheduled airline traffic around the world, circa June 2009 – Credit Wikipedia

 

For every complex problem there is an answer that is clear, simple, and wrong. - H. L. Mencken

 


# 7522

 

With MERS-CoV (along with H7N9 & H5N1) still making headlines, this week a new poll indicates that at least 80% of respondents supported the screening of inbound airline passengers from affected countries for this emerging virus.

 

A Reuters story this week (see Support high for travel screening to stem MERS spread: poll) has the details (excerpt below).

 

More than 80 percent of people questioned in developed countries said inbound travelers from countries with cases of MERS should be screened for the illness. The number rose to 90 percent in less industrialized countries.

 

Support was highest in China, Indonesia and Saudi Arabia, where the illness has been reported, and Italy, which has also been affected, as well as in Australia, Canada and Argentina.

 

While an understandable reaction by the public, there is scant evidence to suggest that screening passengers would do much, if anything, to prevent the entry of a viral illness into a country.

 

It’s not that it hasn’t been tried.  It has. But the success rate has been, well . . .  dismal.

 

The world’s airlines carry 2.6 billion passengers each year, on more than 17 million flights.  And as the graphic at the top of this post indicates, millions of these are international flights.

 

With most viral diseases having an incubation period that ranges from a couple of days to a week or longer, someone who is newly infected with a virus could easily change planes and continents several times before ever they ever show signs of illness.

 

 

And as we saw during the 2009 H1N1 pandemic – even those who are symptomatic will often go to great lengths to get to their destination (see Vietnam Discovers Passengers Beating Thermal Scanners).

 

In April of 2012, in EID Journal: Airport Screening For Pandemic Flu In New Zealand, we looked at a study that found the screening methods used at New Zealand’s airport were inadequate to slow the entry of the 2009 pandemic flu into their country, detecting less than 6% of those infected.

 

Admittedly, New Zealand did not employ thermal scanners.  But countries that did, didn’t fare much better.

 

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Thermal Scanner – Credit Wikipedia

 

In December of 2009, in Travel-Associated H1N1 Influenza in Singapore, we saw a NEJM Journal Watch article on of a new study that had been published, ahead of print, in the CDC’s  EID Journal  entitled:

 

Epidemiology of travel-associated pandemic (H1N1) 2009 infection in 116 patients, Singapore. Emerg Infect Dis 2010 Jan; [e-pub ahead of print]. Mukherjee P et al

 
Travel-Associated H1N1 Influenza in Singapore

Airport thermal scanners detected only 12% of travel-associated flu cases; many travelers boarded flights despite symptoms.

 

In Japan: Quarantine At Ports Ineffective Against Pandemic Flu  I wrote about a study that suggests between asymptomatic or mild infections, and a silent incubation period of several days, there wasn’t much chance of long-term success.

 

For every person identified, and quarantined, by port authorities  - researchers estimate 14 others infected by the virus entered undetected.

 

This is a topic that Helen Branswell of the Canadian press has written about often, including last April in:

 

Airport disease screening rarely worthwhile, study suggests

Helen Branswell, The Canadian Press
Published Wednesday, April 10, 2013 10:11AM EDT

 

Despite little evidence to suggest that passenger screening would be effective, many governments will probably find it difficult not to be seen at least making the attempt.

 

On a slightly positive note, while they may not stop a virus, passenger screening might provide some interesting surveillance data.

 

But practically, as way to keep a pandemic virus from entering a country, it has a low probability of success.

 

The place to try to stop the next pandemic is not at the inbound passenger gate, but in the places around the world where they are likely to emerge.

 

Which makes the funding and support of international public health initiatives, animal health initiatives, and disease surveillance hugely important, no matter where on this interconnected globe you happen to live.

Tuesday, August 14, 2012

Disease Transmission At The Human-Animal Interface

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28 page MMWR Recommendation & Report

 

# 6492

 

 

Recent headlines over the H3N2v flu virus that has jumped from pigs to a small number of humans across the Midwest have made a splash in the media, but the story is neither new, or particularly unusual.  

 

Humans in contact with animals, have always been at some risk of contracting zoonotic diseases. 

 

In a blog last year called The Third Epidemiological Transition, I described how – 100 centuries ago – mankind began to move towards a more agricultural society.  Well respected anthropologist and researcher George Armelagos of Emory University dubbed this the First Epidemiological transition.

 

We began to domesticate animals for food, using their waste as fertilizer, and created more food security than life as a nomadic hunter-gathering society could afford.

 

As we became tied to the land, families grew into villages, villages grew into towns, and towns grew into cities. But with these societal advances also came new diseases. 

 

Q Fever, Anthrax, measles and tuberculosis all gained access to human hosts from domesticated animals.  And with people clustered together in towns, and cities, these diseases were more easily spread among humans.

 

Influenza, while ubiquitous in humans today, is a disease native to waterfowl. It is unlikely that it spread very much among humans until we began to domesticate ducks and geese.

 

SARS, Ebola, bird flu, plague, Rabies, Lyme disease, West Nile, Nipah, HIV, Malaria . . . the list of diseases carried by other species - yet capable of infecting humans - is long and growing. 

 

Last June, in That Duck May Look Clean, But . . ., I wrote about a CDC investigation into an outbreak of Salmonella Montevideo involving 66 persons across 20 states linked to the handling of live poultry (baby chicks or ducklings or both) sold via mail-order hatcheries and  agricultural feed stores.

 

Similar warnings have gone out in the past regarding Human Salmonella Infections Linked to Small Turtles.  Like poultry, reptiles and amphibians can sometimes carry and spread the salmonella bacteria, which makes good hand hygiene particularly important after handling them.

 

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There was an outbreak of Monkeypox – a cousin to the now eradicated small pox virus - in the United States back in 2003, after dozens of people were exposed to infected prairie dogs at a pet shop in Illinois.

 

Last March, in How Parrot Fever Changed Public Health In America, I wrote about how Chlamydophila psittaci, or `Parrot Fever’, spread across the country in 1929, sparking fears of a new pandemic.

 

And just this week (see Typhus alert issued for city of Long Beach) a California city has warned its residents about cases of flea-borne typhus, which may be carried by rodents, possums, raccoons  and cats.

 


With the recent spate of swine flu infections connected with county fairs in the Midwest, the message is going out from local health departments, and the CDC, on the importance of protecting yourself against animal borne diseases.

 

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With the fall school session about to begin, the CDC has published advice on the safe viewing of, and contact with, animals in schools and day care centers. 


A few excerpts follow, but click the link to read the CDC’s advice in its entirety.

 

 

Animals in Schools and Daycare Settings

Photo: Girl looking in jar

Animals can provide important opportunities for entertainment and learning. However, there is also a risk for getting sick or hurt from contact with animals, including those in school and daycare classrooms.

<SNIP>

What types of diseases can animals spread? Can they cause injuries?

In the United States, the biggest risk of human illnesses from animals, especially to young children, is getting infected with germs like Salmonella, E. coli O157:H7 and others that cause vomiting, diarrhea, fever, and abdominal cramping. Animals can also carry germs that cause other kinds of diseases, such as rabies. Animals may have germs on their bodies and in their droppings, even when they appear clean and healthy. The germs can also get on cages, bedding, and wherever animals roam or walk around, and can contaminate these areas.

 

Injuries caused by animals in public settings include bites, kicks, scratches, and others. Most injuries from animals can be prevented if schools and daycare classrooms follow proper safety precautions.

 

How can I reduce the risk of illness from touching or being around animals?

After you touch an animal, or anything in the areas where they live and roam, wash your hands right away to help prevent illness. Read the following tips to learn more about hand washing:

  • Always wash hands right after handling animals, their food, and/or their habitats (for example, cages, water bowls, toys). Also, everyone should wash their hands after going to the toilet, before eating and drinking, before preparing food or drinks, and after removing soiled clothes or shoes.
  • Adults should always supervise hand washing for young children.
  • Running water and soap are best. Use hand sanitizers if running water and soap are not available. Be sure to wash your hands with soap and water as soon as a sink is available.
  • Directions for washing hands can be found here.

<SNIP>

Other Animals Not Recommended in School or Child-Care Settings include:

  • Inherently dangerous animals (e.g., lions, tigers, cougars, and bears).
  • Nonhuman primates (e.g., monkeys and apes).
  • Mammals at high risk for transmitting rabies (e.g., bats, raccoons, skunks, foxes, and coyotes).
  • Aggressive or unpredictable wild or domestic animals.
  • Stray animals with unknown health and vaccination history.
  • Venomous or toxin-producing spiders, insects, reptiles, and amphibians.

(Continue . . . )

Read the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2011  [PDF - 1.33MB]

 

 

Whether is it raising livestock, encountering animals in the wild, or providing a good home to a beloved pet – our interactions with other species enrich our lives. 

 

But as with everything else in the world, there are some risks involved.

 

Knowing the dangers, and taking sensible steps to protect yourself from disease or injury, can help make sure these encounters remain positive ones.

Wednesday, December 15, 2010

Ontario: A Top Ten List Of Infectious Disease Threats

 

 

 

# 5146

 

From a joint study between the Institute for Clinical Evaluative Sciences (ICES) and the Ontario Agency for Health Protection and Promotion (OAHPP) we’ve a study that looks at the relative societal impacts of various infectious diseases in Ontario, Canada.

 

I suspect you  may find their `top ten’ list a little surprising.

 

First an excerpt from their press release, then links to an 8 page summary document, and a link to the full 198 page study.

 

Nearly 5,000 Ontarians die from infectious diseases every year

The Ontario Burden of Infectious Disease Study (ONBOIDS) finds many of top 10 are often overlooked

TORONTO, Dec. 14 /CNW/ - Nearly 5,000 Ontarians die from infectious diseases every year. Many of these infectious diseases get little recognition in terms of public awareness, media attention and resource allocation, says a new study released by the Ontario Agency for Health Protection and Promotion (OAHPP) and the Institute for Clinical Evaluative Sciences (ICES).

 

Led by Dr. Jeff Kwong, scientist at ICES, and Dr. Natasha Crowcroft, director of surveillance and epidemiology at OAHPP, ONBOIDS is the most comprehensive review of the burden of infectious disease in Ontario to date. The study reviewed data on 51 different infectious diseases to determine their impact on the life and health of Ontarians.

 

The ten most burdensome infectious diseases in Ontario are:

  • Hepatitis C virus
  • Streptococcus pneumoniae
  • Human papillomavirus (HPV)
  • Hepatitis B virus
  • Escherichia coli (E. coli)
  • Human immunodeficiency virus (HIV/AIDS)
  • Staphylococcus aureus
  • Influenza
  • Clostridium difficile
  • Rhinoviruses (common cold)

"Each year, Ontarians seek medical attention for more than seven million episodes of infectious diseases. Infectious diseases are not going away, and we as a society need to realize the impact of a number of these diseases," says Dr. Kwong. 

(Continue . . .)

 

Please click here to read the summary report, or here for the full report.

 

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These reports used Ontario mortality statistics from 2003 to 2005, and illness statistics from 2005 to 2007.  


There are a few surprises here, including the ranking of human papillomavirus (HPV) as the infectious disease with the third highest impact.

 

Hepatitis C and B ranked higher than I suspect many would have expected as well, but the authors suggest that provinces with fewer immigrants might see lower rates of those diseases.

 

And it is notable that a number of these diseases (MRSA, Clostridium difficile, Streptococcus pneumoniae) are often contracted as hospital acquired infections (HAIs), highlighting the need for better infection control procedures.

 

Other regions of the world, with dissimilar climates, population demographics, and international travel and immigration patterns would no doubt see a different ordering of their top ten list, with some of these pathogens dropping off, and others moving up.

 

But for Ontario, and presumably other provinces in Canada, this study should help officials decide where best to put their public health resources.

 

Going back to the press release, one of the authors sums it up this way:

 

"It is important to remember that infectious diseases are preventable in many different ways. These findings show where and how we should be concentrating our efforts to get the greatest impact in improving the health of Ontarians. Improvements range from concentrating on immunization programs where vaccinations exist, such as for human papillomavirus, through increasing screening and access to treatment for hepatitis B and C, to developing new ways to fight infectious diseases," says Dr. Crowcroft.

 

 

My thanks to Shiloh on FluTrackers for the link that led me to these reports.

Saturday, September 25, 2010

India: Deep In The Miasma

 

 

 

# 4934

 

 

 

While it is a bit lacking in scientific specificity, an article appearing this morning in Outlook India does give a pretty good overview of the panoply of medical problems cascading through India right now.

 

It is called Deep In The Miasma, and appeared on NewsNow overnight, albeit with a bad link.   With a little digging, I was able to find the right url.

 

This article dangles tantalizing statements, such as:

 

. . .  almost all diseases are showing changes in aetiology, symptoms and even geography . . .

 

. . .  a new variant of bird flu is among the many causes for concern . . .

 

But offers precious little follow through, I suspect primarily because this article appears in the `popular press’ and is filed under Society-Health-Epidemics.

 

In other words, it is geared for a more general audience.

 

 

Disappointingly, the statement about a `new variant’ of bird flu is tossed out, but never clarified, leaving us in the dark as far as to what exactly the authors are referring to.  

 

 

But those quibbles aside, this relatively short article does paint a disturbing, yet fascinating picture of the increasing disease burden being reported across the Indian sub-continent.

 

Including:

  • Dengue
  • Malaria
  • Chikungunya
  • Japanese Encephalitis
  • Typhoid
  • Cholera
  • Gastroenteritis
  • Swine Flu
  • `Mystery’ Fevers
  • Antibiotic Resistance

 

The article also includes a pretty good graphical look at the problem, as well.

image

 

Read:

 

Deep In The Miasma

A monsoon that refuses to go away breeds a panoply of diseases

Amba Batra Bakshi, Snigdha Hasan, Madhavi Tata

Wednesday, May 05, 2010

From the `Nature Bats Last’ Dept

 

 

# 4548

 

 

There is an old joke that goes; as a soon as somebody invents a better mousetrap, nature will begin to work on making a better mouse.

 

And so it seems that whenever we create technological solutions to the challenges nature throws at us, its incredible laboratory begins working to come up with a workaround.

 

Bacteria learn to resist antibiotics, viruses learn to ignore antivirals and drift antigenically to evade vaccines, and eventually your neighbor’s dog learns how to burrow under your fence to get at your prized petunias.

 

Hence the old saying that Nature always bats last.

 

DEET, or N,N-Diethyl-m-toluamide  (a name that, for some reason, never really caught on with the public) is one of our most effective mosquito repellants, and has been for decades. 

 

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Hands treated with DEET (Left) and untreated (Right).

Credit PNAS  Searching for a better mosquito repellent

 

In recent years, some Aedes aegypti mosquitoes have been observed to lose their sensitivity to DEET.  This is concerning since Aedes aegypti are very efficient vectors of diseases like Malaria, Dengue, and Yellow Fever.

 

While there are a great many unanswered questions here, this fascinating report shows that DEET resistance is apparently an inherited genetic trait, and that it can be passed down to subsequent generations of mosquitoes.

 

First this summary from Nature News, followed by the PNAS study abstract.

 

Mosquitoes inherit DEET resistance

Genetic trait explains how some insects are unaffected by powerful repellent.

Janelle Weaver

The indifference of some mosquitoes to a common insect repellent is due to an easily inherited genetic trait that can be rapidly evolved by later generations, a new study suggests.

 

By selective breeding, James Logan and colleagues at Rothamsted Research in Harpenden, UK, created strains of Aedes aegypti mosquitoes in which half of the females do not respond to DEET (N,N-diethyl-meta-toluamide) — a powerful insect repellent. They suggest that this rapidly evolved insensitivity is due to a single dominant gene — one that confers resistance even if the trait is inherited from only one parent.

(Continue  . . . )

 

 

Behavioral insensitivity to DEET in Aedes aegypti is a genetically determined trait residing in changes in sensillum function


Nina M. Stanczyka,b, John F. Y. Brookfieldb, Rickard Ignellc, James G. Logana,1, and Linda M. Fielda

Abstract


N,N-Diethyl-m-toluamide (DEET) is one of the most effective and commonly used mosquito repellents. However, during laboratory trials a small proportion of mosquitoes are still attracted by human odors despite the presence of DEET. In this study behavioral assays identified Aedes aegypti females that were insensitive to DEET, and the selection of either sensitive or insensitive groups of females with males of unknown sensitivity over several generations resulted in two populations with different proportions of insensitive females. Crossing experiments showed the “insensitivity” trait to be dominant. Electroantennography showed a reduced response to DEET in the selected insensitive line compared with the selected sensitive line, and single sensillum recordings identified DEET-sensitive sensilla that were nonresponders in the insensitive line. This study suggests that behavioral insensitivity to DEET in A. aegypti is a genetically determined dominant trait and resides in changes in sensillum function.