Browsing Tag

Infectious Disease

Keep Your Sick Kid Home and Away From Mine!

By December 8, 2015 1 Comment
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We all know that dreaded feeling when you’re meeting with someone and their children, and you can immediately tell that they or their children are ill.

When that happens to me, I mentally start preparing myself for the impending sickness that is almost certain to be passed along to my family, and then I try to manage the disappointment and fleeting rage that momentarily crosses my mind. Sure enough, later that evening I’m usually woken up in the middle of the night by a crying child, and I can tell that something is amiss based on the pathetic-sounding cry and whine. I sleepily fumble my way into to their room only to find a shaky, feverish kiddo that’s miserable and immediately my mind flashes back when I had that sick visitor or play date.

Don’t get me wrong. I’m not a germaphobe, and some exposure to viruses is a good thing. Exposure to some germs is a necessary evil that helps beef up the body’s immunity, allowing our bodies to more effectively fight future illnesses.  One study showcased in Science Magazine has even shown that mice exposed to millions of bacteria and organisms fared better than those mice that essentially were raised in a sterile “bubble,” because their bodies were able to more efficiently fight against illness.

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Categories: Ages + Stages, Infectious Disease + Vaccines, Newborns + Infants, Policy, Politics, + Pop Health, School-Aged Children, Toddlers + Preschoolers, Tweens + Teens

How I Got H1N1 (the “Swine Flu”) and Changed My Mind About Vaccines  

By December 7, 2015 1 Comment
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About 10 years ago I thought vaccines caused autism. I didn’t believe this fallacy with any fervor or passion – in fact, I hadn’t researched it any sense of the word.  It was just something I’d picked up from what I call background noise, the kind of passive media consumption we all tend to do in this super-technical world we live in.

Then I was hospitalized with a vaccine preventable disease  – and I suddenly cared a lot about vaccines, autism and how one person’s decisions can impact a community.

I was in my mid-20s when it happened. I didn’t have any kids or plans for kids in my immediate future, so vaccines and autism were not things at the forefront of my mind. I’d had all my shots as a kid, I got an annual flu shot, but that was about as far as I went when it came to vaccinations.

It was during the height of the H1N1 media hysteria (or the “swine flu,” as it was dubbed, based on its common animal host) when my husband and I attended a party with some friends.  I was 27 and despite the excessive media coverage, catching that virus wasn’t something I was concerned about.  I was young and healthy with no major medical issues.  If I got it, I figured, it would just be a bad flu, and I’d survive. I was above the media hype.

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Categories: Faith + Beliefs, Infectious Disease + Vaccines, Science 101 + Mythbusting

How to Protect Your Family from Viral Meningitis

By October 12, 2015 1 Comment
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There are certain diseases that instantly cause dread and fear when spoken about, especially when it comes to our kids. The mere mention of polio, measles, and meningitis create panic and fear within a community and I should know – I’m the father of an infant and every time we’re told one of these diseases is in circulation, my anxiety level goes up. Most recently, an unusual increase of viral meningitis has been observed in the western part of Michigan, and also in southern Maine. This has health officials very concerned yet determined to inform the public about its increased community presence.

But what is viral meningitis exactly, and how can you protect yourself and your family from this illness?

First, we need to understand what part of the body meningitis affects. The meninges (meh-nen-gees) are the protective layer of tissue that cover your brain and spinal cord. Based on the organs that your meninges protect, you can tell that they perform a very important job. Along with the meninges, a fluid bathes your brain and spinal cord to provide nutrients (called cerebrospinal fluid, or CSF for short). However, it is this CSF fluid that, when infected, leads to meningitis. Your meninges also rely on other tissues to support and enhance its ability to protect your nerves and brain. For example, certain cells in the nervous system produce and secrete fluid that provides nutrients to the brain and spinal cord.

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Categories: Ages + Stages, Infectious Disease + Vaccines, Newborns + Infants, School-Aged Children, Toddlers + Preschoolers, Tweens + Teens

Despite Carson and Trump’s Sidestepping, No, Vaccines Don’t Cause Autism

By September 17, 2015 4 Comments
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There were major face-palms happening during one of the early GOP Debates here at The Scientific Parent’s headquarters when former presidential hopeful Dr. Ben Carson massively sidestepped a pretty simple question about vaccines and autism.

I’m not going to get into the specifics of the debate or comment on the politics, just the piece that concerns us here on our blog, which is all about science-based parenting.

When CNN’s Jake Tapper asked Dr. Carson if he thought Donald Trump should “stop saying that vaccines cause autism,” Carson avoided challenging Donald Trump’s stance directly, (which has been highly public and scientifically incorrect) and said:

ben_carson“Well let me put it this way…there have been numerous studies, and they have not demonstrated that there is any correlation between vaccinations and autism. This was something that was spread widely 15 or 20 years go and it has not been adequately… revealed to the public what is actually going on.”

-Dr. Ben Carson, GOP Debate 9/16/2015

Carson, an incredibly educated physician, went on to redirect the conversation before being interrupted by Tapper, who once again pushed him to disagree with Trump. Which Carson would not do.

While that’s in essence not a problem (challenging someone’s opinion when you would prefer not to engage in a battle), language and presence is persuasive, particularly when you’re an expert in front of tens of millions of viewers. It’s what these debates are all about. You put potential leaders in a room with cameras and you listen to how they command power, expertise, and thoughts on issues that are relevant to the public. And then viewers at home are left with new information, some correct, some not-so-correct, and to make the best judgment call they can about the candidates and the issues from what they know, and what they heard.

Carson is a former pediatric neurosurgeon who has dealt with some of the most medically fragile patients around during his tenure at Johns Hopkins Hospital. He knows the science surrounding the safety of vaccines as he touched on it in his initial response, referencing studies which you can read about in this quick crash course compiled by the CDC. He’s an expert, so one would assume that what he says is accurate.

Posed with the same question, Donald Trump, whose command of authority is essential to his business image, did not stand down from the question:

trumpface“Autism has become an epidemic. Twenty-five years ago, 35 years ago, you look at the statistics, not even close [to what it is now]…I am totally in favor of vaccines but I want smaller doses over a longer period of time.”

–  Donald Trump, GOP Debate 9/16/2015

And, after alluding to a baby being “pumped” with vaccines in the amount “meant for a horse,” he pointed to evidence of an employee of his, whose child “…went to have the vaccine and came back and a week later got a tremendous fever, got very, very sick, now is autistic.”

Trump concluded by pointing to vaccine spacing as what will reduce autism in America. Since vaccines aren’t linked to autism, and science backs that, how does spacing non-autism-causing shots reduce autism? It’s a mystery to us. But it does have an undercurrent of the conspiracy theory about pediatricians we’ve addressed before on The Scientific Parent. And I’m not even going to touch the epidemic and anti-autistic language here. That’s for another time, and another post.

Where I nearly flipped a table over is when Carson followed up to Trump’s comments by agreeing with Trump about vaccine spacing, and then reiterating his stance that vaccines don’t cause autism. The doctor said WHAT?

Though children get nearly two dozen vaccination shots by the time they are two years old (for a series of deadly, preventable diseases), there’s no general belief in the medical community that this nationally applied schedule of vaccines is a problem for healthy children. In fact, the CDC and American Academy of Pediatrics recommend the current vaccine schedule based on what is considered safe and prudent according to a wide array of factors, most important being what a child’s immune system is able to tolerate at different points in their growth and development, and what’s absolutely essential to protect them against at the earliest possible age.

Vaccines from 0-6

Example vaccine schedule from CDC, ages 0-6: http://ow.ly/SkmZM

Not convinced yet? Take a look at this document, which explains what the Advisory Committee on Immunization Practices is. It’s a panel of experts who are rigorously vetted and have a range of expertise, and they have multiple public meetings a year where they review a range of information, research, and clinical data to determine what’s safest for children. They’re the ones who provides the CDC with schedule recommendations. And I’m pretty sure they know a lot more than either Mr. Trump or Dr. Carson could dream about vaccine science and safety.

So again, challenging someone you don’t want to challenge is in essence, not a problem. What is a problem however, is for a nation that’s worked hard to eradicate so many tragic infectious diseases, to have Dr. Carson publicly representing pediatric medicine and not correcting something that is a matter of life, death, and severe disability through disease injury for millions of Americans and their children. We’ve covered that elsewhere on this blog, which you can read here, here, here, and here. We really, really hope he moves to correct this in upcoming public statements, and we’re not alone.

Misinformation of this nature spreads quickly and keeps its hold for a long time, because oftentimes it’s rooted in fear. Trump’s vaccination stance has been highly visible and what he says, if it were true, is scary to even consider. A few snapshots of his comments on Twitter, for example:

Trump Twitter 3

 

Trump Twitter 1

When you’re an expert in medicine and you allow misinformation to linger as Dr. Carson did, particularly misinformation that can be fatal if in the wrong hands, it can have massive impacts. It can lead to malpractice if you’re an actively practicing or teaching physician. And in front of a nation of attentive TV viewers, it can lead to a whooooole lot of people listening to the more bold candidate and believing that he or she is speaking the truth. It’s what terrifies the masses that leads to situations such as what happened with Tara Hills, the formerly anti-vaccination advocate mother of 7 children who ended up with whooping cough, who was misinformed and fearful by messages similar to what Trump said on stage last night.

The damage is done, though many, many websites and blogs such as our own took to the interwebs that night, as we do often, to argue in favor of science and safety.

Ask anyone who works or has worked in broadcast and we’ll tell you the same thing. People (myself included) tune out after the first few seconds of a soundbites, and they surely did given how circular political-speak can get during those debates.  Lets just hope that for a nation dependent on vaccinations for so much of its basic health protection, we can keep the facts straight from the opinions. Cast your vote where you may, but protect your kids, please, they’re our most precious candidates for this nation’s future.

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

What “Fear the Walking Dead” Gets Right About Public Health

By August 24, 2015 No Comments
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When I was 16 weeks pregnant with my son I caught a nasty head cold. Unable to take any of the traditional over the counter cold medications (because, pregnancy), I was forced to ride it out in misery on the couch praying for my own swift demise. The cold knocked me down hard and by the second or third day of misery on the couch I had binged watched just about everything I could binge watch.

Then I came across The Walking Dead on Netflix. Now, I had very particularly avoided watching the show because my fellow #publichealthnerd colleagues had pressured me to watch it, and urging me to do something is the best way to get me to not do that thing. I’d also avoided watching it because I’m not a fan of horror.  Blood and guts are not my preferred form of entertainment. Sure, give me intrigue, drama, suspense and I will eat it up (hello House of Cards and Mad Men) but toss in zombies or vampires? I’m out.

But it was a few days before Hallowe’en* and I was 16 weeks pregnant, miserable, and out of binge-worthy TV. I decided to give the first episode a watch…and I haven’t looked back since. Well, except during the really gory scenes. Where I literally look backwards.

As a public health nerd, I can say that there have been times where from a public health standpoint the show has been laughable. The season one finale where our group of survivors winds up at the CDC?(OH COME ON!) Nothing that the show depicted about the CDC’s facilities in Atlanta is even remotely accurate. Even the evidence the CDC researcher claims to have (as in, shooting someone while in an MRI machine? OH COME ON!!) was preposterous.

Don’t even get me started on the idea that the CDC somehow, somewhere, has billions of dollars squirreled away for a state-of-the-art underground command center. Please show me the line item for that in the annual congressional allocation. I’m sure if Congress did earmark funds for a Dr. Evil-like underground lair, there would be a deafening outcry from both within and without the CDC for the desperate need for that funding to go towards more pressing public health concerns. Like anything not secret-underground-lair-ish.

I digress.

When the announcement came early this year that there would be a spin-off show of The Walking Dead, detailing the beginnings of the zombie apocalypse, I was intrigued, if not concerned. After the complete media fail that was the news coverage for Ebola in America I was suspicious about how the show would portray public health infrastructure, and to be frank after the premiere I still am, but the premiere gave me much to be hopeful about.

*** WARNING, VERY MILD SPOILERS BELOW ***

The family at the center of Fear the Walking Dead c/o AMC.com

The family at the center of Fear the Walking Dead c/o AMC.com

The premiere episode does do a great job of highlighting the world as it currently is. We have made accommodations, and in fact are comfortable with, symbols of fear in our daily lives against things like violence (metal detectors in high schools, bars on the windows of homes, police activity). Likewise, we’re somewhat oblivious to more insidious threats like drug abuse and infectious disease.

What the show does get right in terms of science in its first episode is the emergence of the Walking Dead’s infamous zombie virus in an intravenous drug using population. A variety of infectious diseases have presented first or early among members of this group, including HIV/AIDS and numerous bacterial infections.

The reason for this is simply because of the behaviors associated with the practice; needles are often shared, and blood and other bodily fluids are exchanged,making it the perfect scenario for bacteria and viruses to replicate and mutate.

The demographics of IV drug users also interferes with what public health nerds call epidemiological surveillance. Epidemiological surveillance is how public health officials monitor what viruses, infections, and diseases are prevalent in a given population. The most common form of this surveillance is through passive surveillance, which is when an individual reports to their health care provider with an illness or concern and its documented, instead of public health officials actively seeking out cases.

If this sounds a little creepy, it’s actually not. Typically, and depending on the disease, your doctor or hospital isn’t reporting to the CDC that you, Jane Doe, born on this date, had the flu. What they’re reporting are generalities, so that public health officials can assess where resources would be best allocated. What your doctor or hospital reports is that a female, in this age range had this strain of flu at this time.

But the fatal flaw in passive surveillance is that it requires people to actually go to their health care provider. Unfortunately IV drug users tend to lack the means to seek out timely medical care. In many cases, a lack of a regular income, health insurance, fear of being reported to the police, or simply fear of judgment means that people often wait until an illness has reached a crisis point before they seek medical care. This means that illnesses can circulate undetected in the population for a longer period of time than they would in a population without similar barriers to accessing health care.

When looking for their son, whom they fear has fled hospital to score heroin, the main characters of Fear The Walking Dead drive through several rough neighborhoods where “Missing” posters have gone up on walls and fences. The implication the audience is meant to intone from these posters is that there is a massive outbreak underway that the powers-that-be are not yet aware of, because of who the missing (we know to be zombified) individuals are.

The genesis of the zombie virus in an intravenous drug using population was something I wasn’t expecting from the show, but something I find completely plausible (as plausible as a zombie virus can be).  I was concerned considering the show’s previous ridiculous portrayal of the federal public health infrastructure, that the writers would go in the direction of a government-engineered virus released on an innocent and unsuspecting public.  If they’d done that, I would have been out immediately and I have to admit, it probably would have ruined the original Walking Dead series for me as well.

I have to say, Fear the Walking Dead has stepped up its game in terms of scientific accuracy, which I greatly applaud.  But I’m obviously not watching it for that – or maybe just partially. As my husband can tell you, I’ve spent a good chunk of time watching The Walking Dead yelling at Rick and his crew “FOR THE LOVE OF GOD, HOW HAS NO ONE DIED OF A STAPH INFECTION YET?!”  Robert Kirkman, if you’re listening, someone on the show needs to step on a rusty nail and die of tetanus.

*I’m Canadian, so I spell Hallowe’en with an apostrophe

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Categories: Policy, Politics, + Pop Health

How Did E. coli Wind Up in Bottled Water? Spoiler Alert: Poop

By July 14, 2015 No Comments
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Just as summer started in late June, officials from Niagara, LLC initiated a large recall of their bottled water due to evidence of E. coli at the company’s spring water source. This was cause for concern for many people, including parents, as summer is when bottled water is a regular go-to and most in demand, and of course because E. coli has earned a (rightfully) bad reputation.

It may make your skin crawl to think about it, but on and in just about every living thing, there’s a whole host of naturally occurring microbes. This includes humans. That’s right, naturally occurring microbes have taken up residence in your skin and gut and you need them to live.

Eschericia coli or more simply E. coli is a naturally occurring and very important microbial resident in the digestive tracts of cattle, ruminants (sheep, goats and deer), mammals and birds. People often think that E. coli is a single type of bacteria, but in fact it’s a large and diverse group of microbes.

In animals, E. coli is classified as a commensal microbe, which means that the bacteria lives within these animals without causing disease and helps the animal’s digestive tract extract important nutrients from food. These bacteria, like the ones that live in our guts, eventually they die and are shed when the animal defecates (see: poops).

So, if E. coli is a naturally occurring bacteria why is it a problem when it gets into the human food supply?

In 1982, a new subtype of E. coli was discovered in cattle that were very distinct from the standard E.coli shed by animals for the benefit of their health. This new subtype named 0157:H7 still lived in the animal’s gut and was shed through the same method (see: poop). In 1993 the new subtype was identified as the cause of a large outbreak of an illness that caused hemorrhagic diarrhea, kidney failure and even death. The common thread among all of the victims were that they’d consumed undercooked beef from a large fast food restaurant.

So if E. coli 0157:H7 lives in the guts of animals, how did it get into hamburger meat in 1993 and how did it get into the Niagara, LLC bottled water supply?

In 1993 the outbreak was traced to meat processing plants that lacked protocols to ensure that bacteria from the animal’s gut didn’t contaminate the meat used for human consumption. In terms of the issue with Niagara, LLC it comes down to how we handle poop: our own and that of animals.

Humans have built intricate sewage systems that handle our waste en mass, but the same cannot be said for animals such as cattle. During periods of heavy precipitation or snowfalls, E. coli can potentially be washed into bodies of water used for swimming and drinking. Another potential source for E. coli are from raising cattle. Human farming practices such as irrigation can carry animal waste from fields into close contact with crops and potentially into bodies of water used by humans.

E. coli infections with the serotype 0157:H7 are the most common cause of disease via the production of a shiga toxin. The toxin and the resulting disease can infect almost anyone but the very young and the elderly are most at risk. The primary symptoms are abdominal cramps, vomiting and bloody diarrhea. These populations can develop hemolytic uremic syndrome (HUS), which can lead to kidney failure and death.

Niagara LLC acted very responsibly after learning that the potential for infection was present and began the recall. Their products reach a very wide customer base in multiple states through a number of retail outlets. Prevention is typically the best method of reducing chances of infection and these preventative methods are usually very simple.

  1. Wash your hands after going to the bathroom, prior to and after preparing food and after changing diapers.
  2. Avoid swallowing water when swimming in lakes, rivers and kiddie pools.
  3. Properly handle and cook meats.
  4. Do not consume raw milk or unpasteurized juices.
  5. If you suspect that you or your child is sick, consult with your health care provider immediately.

These outbreaks do not occur as often but when they do, the effects have a major impact on the population at large. As consumers, we have to be very prudent in the choices we make and using the prevention methods at hand to keep our families safe. – Edited by Leslie Waghorn

 

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Categories: Food, Nutrition, + Infant Feeding, Infectious Disease + Vaccines

Americans, Public Health Rules are Different in Other Countries. Adjust!

By June 30, 2015 1 Comment
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American families traveling outside of the country this summer for a vacation, heads up, you might want to see your doctor before your trip. Whether you’re driving an hour to Canada or Mexico or flying across an ocean, there are two key things you want to consider, even if you’ve done your particular journey many times before:

  1. What vaccinations are recommended for the areas that you’re traveling to?
  2. What extra medications might you need to bring with you in the event that you or your children do get sick, and can’t quickly access familiar healthcare options (pharmacies, drugstores, physicians)?

I’m going to focus on travelers’ vaccines in this post, because it’s not the first thing that parents typically think about when going abroad.  To be clear there’s no law or mandate requiring you to get certain vaccines in order to travel abroad, in fact it’s just the opposite.  The State Department and CDC make recommendations, but it’s up to each individual and each parent to make those decisions for themselves based on the risk they perceive.

We all judge risk differently, and depending on the disease, the risk of contracting it may seem small enough to skip the recommended vaccines. But many of the worst infectious diseases you’d contract both here and abroad are actively avoidable, and the so-called “best case” scenarios of catching and recovering from those diseases with little impact are rare, exceptional, and statistically unlikely. After all, deadly infectious diseases, as they’re named, can kill you. They can permanently harm you. And they can leave you and your kids incredibly ill, suffering, and in quarantine, much like the recent case of the 6-year-old boy in Spain whose parents refused to vaccinate for diphtheria. After being in treatment for weeks with that deadly illness, that boy recently died.

Staying unvaccinated in the face of risk is a gamble with what is most precious – our lives.  I don’t feel comfortable taking that gamble because I’ve seen the statistics and science, and they’re stacked against any other decision. This issue came up recently as my soon-to-be stepsons are heading off to Mexico on vacation in a few weeks, a place that they frequent with their other half of the family since it’s literally an hour south of our collective homes in San Diego, California.

My fiance ran across the CDC traveler’s vaccine recommendations for Mexico via the State Department’s website as he was renewing his Passport two weeks ago, and found a recommendation for travelers to get both the Typhoid Fever and Hepatitis A vaccines for trips to Mexico, in addition the standard vaccines that most of us already have. When he spoke to the boys’ pediatrician about it, the physician seconded that recommendation. Though they hadn’t had the shots before, to be fair, travel to Mexico isn’t really a huge deal here. It’s a pretty acceptable and normalized option for many people for their day trips, family visits, and cross-border commutes to work. But during an informal poll of mine, I found that there seems to be a misconception that going to Mexico is really not like visiting a typical “foreign country,” and there are no needed travelers’ vaccines. That’s actually incorrect.

The oral Typhoid Fever vaccine - taken as 4 pills over 1 week

The oral Typhoid Fever vaccine – taken as 4 pills over 1 week

Despite its familiarity and its proximity, Mexico resides outside of the bounds of the U.S. public health bubble. That means that nation’s population doesn’t have the same vaccination requirements, statistical herd immunity, or public health rules and regulations for food handling, hospitals, etc. Many locals here might be surprised to learn that despite its proximity to San Diego, Mexico is actually considered a “developing” country, which is a fancy-shmancy term that captures a wide range of development, economic, and human factors. The designation also means that you as a traveler need to be cognizant of where corners may be cut in public funding (specifically for the purposes of this post, healthcare, and cheap/free vaccination availability), and take the appropriate precautions to safeguard your health. For my fiance, that meant he realized the boys needed to get their Typhoid vaccinations ASAP if they hadn’t already.

One of the many things the boys are excited about for this trip is that they’re staying at a resort location; but it’s also a reason given for why they might not need these vaccines, after all, it’s in a well-developed part of the country.  But just because they’re staying at a high-end resort, doesn’t mean they’re any safer from these diseases. I’m here to tell you that you don’t need to roll around in garbage and poop (yes, I said poop) in the jungle with no doctors for miles to get sick from something abroad. Sometimes it’s as easy as touching our faces after touching something contaminated that we were completely unaware of. Otherwise, we wouldn’t be taught to wash our hands the way that we do after we go to the restroom – after all, germs are invisible.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Typhoid Fever is definitely something along those lines, something that spreads largely through poor hygiene practices, since it comes from Salmonella Typhi, a bacteria that only lives in humans’ bloodstreams and intestinal tract, and gets transmitted easily, typically through contaminated food or drink (contaminated by, you guessed it, fecal matter). It’s not common in the U.S. with an estimated 6,000 cases per year, with 75% of those coming from international travelers. In developing countries, it affects a staggering 21. 5 million people a year – and it killed an estimated 161,000 people worldwide in 2013. Per the reports (and the one man I know who has had it, and got it from a 5-star resort abroad!), it takes 1-2 weeks to fully show up in an infected individual, it lasts around a month with treatment, and it’s awful: high fevers of up to 104 degrees Fahrenheit, a rash, exhaustion, delirium, swollen organs, and in worst case scenarios, internal bleeding and death.

So this was an issue easily remedied. Fortunately, these days, 4 simple pills taken over the course of a week can prevent all of that. A small copay, a series of pills, and the boys are now ready to go, teenage hygiene and poop threats be darned! Even better, they’ll be protected against the majority of cases for the next 5 years.

As Americans (and I’m talking generalities, of course), we tend to have an oblivious attitude toward how different things can be in other cultures and countries. And things are not always what we assume they are (read: the same as we are accustomed to), no matter how similar they may look. When confronted with this reality, we can fight it, avoid it, or we can just get over it, already, and adjust our behaviors in a way that best serves us and our children. So, adjust, protect, and avoid the awful things you can. There’s plenty of time to catch Monteczuma’s revenge in the meantime, if you really want to get sick while you’re abroad. Just remember to get a prescription of traveler’s antibiotics and some Pepto before you go.


Resources:

Centers For Disease Control Travel Center Accessed: 06/29/15

 US Passports and International Travel Country Information State Department. Accessed:  06/29/15

 Boy Dies Diphtheria Spain, Parents Rejected Vaccine ABC News/AP News. 06/27/15. Accessed: 06/29/15

 Country and Lending Groups .World Bank Data. Accessed: 06/29/15

 Community Immunity. Vaccines.gov. Accessed: 06/29/15

Germs. Communicable Disease Control and Prevention. San Francisco Department of Public Health  Accessed: 06/29/15

Typhoid Fever National Center for Emerging and Zoonotic Infectious Diseases. CDC.Gov. Accessed: 06/29/15

GBD 2013 Mortality and Causes of Death Collaborators. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), 117–171. doi:10.1016/S0140-6736(14)61682-2

The New York Times Health Guide: Typhoid Fever. Accessed: 06/29/15

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health

The Water-borne Vibrio vulnificus Bacteria: What Are the Risks?

By June 24, 2015 3 Comments
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It’s already been a difficult year for beach goers on the east coast, as if shark bites on two different beaches in North Carolina weren’t bad enough now the most recent scare: what the media is calling a”flesh-eating bacteria” in Florida.  A recent report noted that 7 Floridians have been infected with the Vibrio vulnificus organism so far in 2015, and three of them have died.

Understandably, when terms like “flesh-eating bacteria” are thrown around as it has been in the case of V. vulnificus, fear follows.  That’s one reason health departments don’t like that term—and it’s not scientific, in any case, as the clinical term is “necrotizing fasciitis.” Various news outlets have reported deaths and serious infections this year associated with “flesh eating bacteria,” but these are not all due to Vibrio vulnificus. In this news story, the cause of infection is actually a completely different organism called Streptococcus pyogenes, but they inexplicably discuss Vibrio vulnificus throughout the body of the story, clearly not the same thing. So, let’s sort out just what V. vulnificus does, and how concerned a parent should be.

What is Vibrio vulnificus?

Vibrio vulnificus is part of a group of bacteria that typically cause gastrointestinal illnesses, including vomiting and diarrhea. The best known of the Vibrio family is probably the organism that causes cholera, a water-borne disease that is frequently life threatening. While Vibrio cholerae causes somewhere on the order of 2-4 million cases of illness and up to 140,000 deaths worldwide per year, it is rare in the United States; most cases of cholera diagnosed here are due to international travel. More common are other members of the Vibrio bacteria family. Vibrio parahaemolyticus is the most common Vibrio infection in the United States, and like its cousin V. cholerae, it causes gastroenteritis (though it’s typically much more mild than cholera). Most cases of V. parahaemolyticus infections come from eating seafood, such as oysters, clams, and mussels—especially when they are eaten raw. V. vulnificus can also cause gastroenteritis, but it’s not very well-described. Like V. parahaemolyticus, most cases of V. vulnificus gastrointestinal disease have been linked to seafood, and especially oysters and shrimp.

More commonly, V. vulnificus causes skin and soft tissue infections or “SSTIs.” These can range from a mild skin infection to a very invasive disease, including necrotizing fasciitis (the misrepresented “flesh eating” component), where the fascia—the tissues that line and separate the muscles—are attacked by bacterial infection. As the bacteria spread and these tissues die, infections like these can require amputation of the infected limb or removal of diseased tissue—that’s where many of the most gruesome reports of these infections come from. It’s also worrisome because symptoms can progress very quickly. Symptoms can present in less than 12 hours from exposure to the bacterium, and death can occur within 24-48 hours. In the worst case, these infections can lead to bacteria in the blood (sepsis), and death.

Where is it found?

Courtesy: CDC/James Gathany (PHIL #7815) via the CDC Public Health Image Library

Courtesy: CDC/James Gathany (PHIL #7815) via the CDC Public Health Image Library

V. vulnificus is most commonly found associated with waters of the Gulf of Mexico and the Atlantic seaboard, though it can be found in other areas as well. It can be associated with natural disasters – an increase in V. vulnificus infections was detected following Hurricane Katrina and the hurricane’s associated floodwaters. The bacterium flourishes in brackish waters, where fresh and saltwater merge, and is thought to be increasing in abundance due to decreases in ocean salinity associated with climate change. It also is more common in the summer months, due to rising water temperatures that encourage bacterial growth. Most cases occur between May and October. In Florida, V. vulnificus is the most common Vibrio illness, associated with wound infections primarily, and oyster consumption secondarily.

How common is it?

Luckily, not very. One report documented only 944 cases of V. vulnificus infections reported in the United States between 2001 and 2009. States in the Gulf Coast region average about 50 cases, 45 hospitalizations and 16 deaths annually, according to the Florida Department of Health. It should be noted that this is probably a low estimate, as many individuals with mild infections may not go to a physician for diagnosis and treatment. Of those who do become ill with V. vulnificus, many of them have other health conditions that make them more vulnerable, in particular, people with diabetes, liver disease, alcoholism, or cancer are particularly susceptible.

How can it be avoided?

For the vast majority of people, coming into contact with V. vulnificus will not result in any harm. Those who are at risk include individuals with pre-existing conditions as noted above, and individuals with open wounds. Carefully covering wounds, or better yet, staying out of the water if an open wound is present, can reduce the chance of acquiring a serious V. vulnificus infection. Avoiding brackish waters can also lower one’s risk. If you experience a cut or scrape while swimming, clean the wound carefully and seek medical attention immediately if it becomes swollen, red, and/or hot to the touch. Wear shoes or some kind of foot protection in rocky areas, to avoid cuts that can introduce V. vulnificus. Cooking seafood rather than eating it raw will also lessen exposure to the bacterium.

While V. vulnificus can be scary, the risk to healthy individuals is quite low, particularly if simple precautions are followed. Have a good time at the beach, and with simple precautions, you should likely be more concerned about sunburn than a “flesh-eating disease!”

 


 

Resources:

Brian Clark Howard. What You Should Know About Shark Attacks After Recent Bites. National Geographic. Accessed 6/23/15

Officials: Don’t call it ‘flesh eating bacteria’. Wstp.com – Channel 10 News. Accessed 6/23/15

Philip Ross, Flesh-Eating Bacteria From The Ocean? Necrotizing Fasciitis Coming To US Beaches This Summer. International Business Times. Accessed 6/23/15.

Janda JM, Newton AE, Bopp CA. Vibriosis. CLin Lab Med 35:273-288. 2015. Accessed 6/23/15.

Scott Gold, Newest Peril From Flooding Is Disease. Los Angeles Times, September 6, 2005. Accessed 6/23/15.

Weis KE, Hammond RM, Hutchinson R, Blackmore CG. Vibrio illness in Florida, 1998-2007. Epidemiol Infect 139:591-8. 2011. Accessed 6/23/15.

 

 

 

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Categories: Infectious Disease + Vaccines