Pilgrims and Pandemics: Hajj, Umrah, and MERS

Click here to check out my blog post for George Washington University‘s International Health Regulations Blog!

The Hajj and Umrah, the two largest pilgrimages of Islam, both take place in the Kingdom of Saudi Arabia. This presents a public health concern, as millions of people from all over the world will be coming to the country that has reported the largest number of MERS-Coronavirus cases.

Preparing for Hurricanes

Display of tax-free hurricane supplies outside a Virginia Home Depot (C) Hillary Craddock, all rights reserved

Display of tax-free hurricane supplies outside a Virginia Home Depot (C) Hillary Craddock, all rights reserved

Hurricane season officially starts for the Atlantic Coast June 1, and weather experts predict that the 2013 hurricane season will be more dangerous than normal. The National Oceanic and Atmospheric Administration (NOAA) predicts as many as 20 total named storms, which could include seven to 11 hurricanes and three to six major hurricanes. Accuweather also predicts a worse than normal hurricane season, with 16 tropical storms and eight hurricanes. They predict that four of those will be major hurricanes, and that three of those will make U.S. landfall.

So what can you do? It’s simpler than you may think – Get a kit. Make a plan. These two simple sentences have been used by everyone from the Red Cross and CDC to state and local health departments to encourage everyone to be prepared. Kits help ensure that you can either take shelter safely in your home or evacuate quickly and safely. A plan helps you care for yourself and your loved ones, even your pets and livestock. Continue reading

Link Aggregation: 1/26/13

Disaster Response:

The CDC’s Office of Public Health Preparedness and Response has recommended the site Do 1 Thing as a good starting point for preparing yourself and your family for a disaster. Do 1 thing sends free monthly suggestions on simple ways to prepare yourself, your family, and your community, and they also offer materials in large print, audio format, braille, Spanish, Chinese, Nepali, Arabic, Swahili, Somali, and Burmese.

An article about cholera in Haiti provides a really cool look at how the health of responders is an important factor to consider in emergency management.

A great article on disaster planning for people with horses.

Science Communication:

Occam’s Typewriter blogger summarizes the #overlyhonestmethods trend on twitter.

Also in twitter, #MiddleEarthPublicHealth discussed population health concerns in Lord of the Rings.

I absolutely love the video blog The Brain Scoop. Check out one of their videos below!

Public Health Emergency: Influenza 2013

Members of the U.S. Army receiving the flu vaccine. Source: Flickr Creative Commons, (C) U.S. Army

Members of the U.S. Army receiving the flu vaccine. Source: Flickr Creative Commons, (C) U.S. Army

Recently the State of New York and the City of Boston have both declared public health emergencies. A Pennsylvania hospital (Lehigh Valley) has set up surge tents outside the emergency rooms to handle any patients with a fever. While last year’s flu season was incredibly mild, this year has been very different. The flu is becoming much more widespread much earlier in the season, and the strain in question is causing severe illness. for example, in Boston 25% of reported cases (a case is reported any time someone tests positive, so any time you go to a doctor and get swabbed you are being tested, and those data are being reported) are requiring hospitalization.

What is a Public Health Emergency?

Essentially, a Public Health Emergency is declared when a state or city (or the entire country) needs to release resources (monetary resources, vaccine stockpiles, healthcare providers, ect.) to handle a threat. These are bad situations (or imminent threats) requiring lots of people, supplies, and funds to deal with. For example, part of the emergency declaration in NYC allows pharmacists to give vaccines to children between the ages of 6 months and 18 years. Ordinarily  pharmacists can only administer vaccines to adults, but since children are considered an at-risk group for severe influenza the emergency declaration waived that regulation. Continue reading

My, what an impressive nose you have: How rats could help detect Tuberculosis

Adorable and a TB detection device!

Adorable and a TB detection device! Source: Wikimedia Commons

Dogs have powerful noses; they can be trained to sniff out anything from land mines to cancer. However, they are not the only furry, four-legged creature that relies on a keen sense of smell. The Gambian pouched rat (Cricetomys gambianus, also known as the African giant pouched rat) is a large rodent (not technically a true rat) that relies heavily on its sense of smell.

What does this have to do with Tuberculosis? TB bacterium omit a Volatile Organic Compound (VOC), which can then be detected by smell. The rats are being utilized in countries that can’t afford state-of-the-art testing methods, which can cost more than 20 USD per sample and require the purchase of tens of thousands of dollars worth of equipment. TB disproportionately affects resource-poor nations; more than 95% of deaths due to TB occur in low- and middle-income countries. Continue reading

Chronic Wasting Disease: A New Threat To Pennsylvania Deer, No Gun Required

Dinner. Unless he has CWD. Source, Wikimedia Commons, (C) USDA, Agricultural Research Service

This post was originally published at Mind the Science Gap on Nov. 29, 2012.

In early October a deer tested positive for Chronic Wasting Disease for the first time in Pennsylvania. The positive result, which was found in a farm herd, resulted in the quarantine of all the deer on the property. Earlier this month, a deer escaped the quarantine and was running free in Pennsylvania. Two days ago that deer was shot and killed to prevent further disease transmission. That doe is still undergoing testing to determine if she was infected. As a result of all of these events unfolding, Pennsylvania has swiftly put plans into action. Chronic Wasting Disease (CWD) is nearly impossible to eradicate once it establishes itself in a population, and in order to save PA’s deer herds, they needed to act fast.

Chronic Wasting Disease is endemic (established in wild populations) in Colorado and Wyoming. It has also been reported in wild herds in Illinois, Kansas, Maryland, Minnesota, Missouri, Nebraska, New Mexico, New York, North Dakota, South Dakota, Texas, Utah, Virginia, West Virginia, and Wisconsin. CWD has been found in captive herds in other states, such as Iowa. States with no confirmed cases often have CWD task forces and policies to prevent introduction of the pathogen. For example, Washington recently began requiring hunters returning from CWD-endemic areas to undergo testing and processing to remove infectious material.

CWD is a type of transmissible spongiform encephalopathy (TSE), a group of disease that includes Bovine Spongiform Encephalopathy (Mad Cow), Scrapie (a disease commonly found in sheep), Creutzfeldt-Jacob disease (a neurodegenerative disease in humans), and Fatal familial insomnia (a disease where protein misfolding results in insomnia which progresses to delusions and eventually death). TSEs are all caused by a pathogenic organism known as a prion. Prions are rather unique in that they are not a virus or bacteria, but a protein with an abnormal structure. These prions can be infectious and transmissible (like CWD and Mad Cow) or inherited (like the fatal insomnia). Continue reading

Food safety: Stuffing the turkey…with disease!

You want to stuff what?! In where?! Source, Flickr creative commons, (C) donjd2

This post was originally posted at Mind the Science Gap on Nov. 22, 2012.

If you’re reading this from the hospital, it may be too late. If you’re feeling a bit queasy after a big meal of turkey, stuffing, and veggies, you may want to eat an antacid before continuing to read.

Stuffing and Disease

Cooking a stuffed turkey has been linked to food-borne illness. The problem stems, not from the inherent danger of stuffing, but from the cross-contamination of stuffing with turkey juices. If the now-potentially-bacteria-laden stuffing does not reach the same internal temperature as the meat (165 degrees F), there is a risk that bacteria from the meat may survive the cooking process.

In 2009, Greig and Ravel analyzed internationally reported foodborne outbreak data for source. 105 outbreaks were attributed to turkey and other poultry (not including chicken) between 1988 and 2005. (It is important to remember in this instance that an outbreak of disease means that more cases are reported than normally expected for that time frame.) These outbreaks included Clostridium perfringens (botulism’s less deadly cousin), Campylobacter (which causes diarrhea, sometimes bloody), E. coli, Listeria monocytogenes (the causative agent of listeriosis, one of the nastier food-borne illnesses. 20-30% of cases result in death), multiple types of salmonella and staph, and norovirus. (I can ensure you that there is no faster way to ruin a holiday than to infect your whole family with norovirus. Or listeriosis. ) Continue reading

Botulism in the Great Lakes: Not just for canned foods anymore

Common Loons, Source: flickr creative commons, (C) Ano Lobb

This post was originally published at Mind the Science Gap on Nov. 8, 2012.

Less than a month ago, volunteers at Sleeping Bear Dunes started noticing a problem. Dozens of loons and other aquatic birds were washing up from the Great Lakes, dead from botulism poisoning. While botulism is present in the Great Lakes and birds do die from it, biologists are reporting that the ducks are dying in far higher numbers than usual. Botulism is usually associated with improperly prepared canned goods, so why is it swimming around the Great Lakes?

First off, What is botulism?

Botulism is an illness caused by the toxin produced by a specific type of bacteria – Clostridium botulinum. This toxin causes muscle paralysis, and if untreated can result in death. Treatment can include pumping the victim’s stomach, flushing the lower gastrointestinal tract with an enema, or administration of an antitoxin. (Not a pleasant experience, I am sure.) Continue reading

Disaster Response: Citizen by Day, Responder by Night (or afternoon, or morning…)

NYPD truck driving down the flooded FDR Drive during Hurricane Sandy, Source: Flickr Creative Commons, (C) david_shankbone

This post was originally published at Mind the Science Gap on Nov. 1, 2012.

The e-mails started on Friday. The director of my home county’s Medical Reserve Corps (MRC) sent out a request that all volunteers report their status for the upcoming hurricane. Would we be available in the event that Hurricane Sandy hit Northern Virginia? As the news reports came in and bloggers up and down the eastern seaboard reported what was going on, I couldn’t help but feel like I should be down there. I’ve spent most of my life on the East Coast; many friends and family members were hunkering down and waiting for the storm to pass. Thankfully, everyone I know pulled through safely.

Before I got involved in public health, my mental image of disaster response was a mish-mash of government response and spontaneous volunteers. The images of Hurricane Katrina on TV showed FEMA agents and uniformed National Guardsmen in one clip and college students and church groups in another. However, there is a middle ground – organized groups of people who train to specifically respond to disasters on a volunteer basis. The category of is a broad, and it includes many EMTs, firefighters, response teams, and search and rescue teams that have day jobs and work alongside their full-time colleagues. For the sake of this article, I’m going to focus on the groups that anyone can join regardless of experience. Continue reading

Deadly Fungal Meningitis Outbreak: What is it and what you can do

States where healthcare facilities received contaminated lots of steroids (C) CDC

This post was originally published at Mind the Science Gap on Oct. 25, 2012.

As of 4:30 PM on October 24th, 24 deaths have been reported due to a multi-state outbreak of fungal meningitis (swelling of the membranes of the brain or spine caused by a fungal infection). It is believed that the culprit is contaminated steroids, specifically methylprednisolone acetate, an injectable steroid to treat back and joint pain. While investigation of the causes of this outbreak is ongoing, specific lots of steroids made by the New England Compounding Company (NECC) have been pulled from use. NECC has since voluntarily ceased operations, recalled all products, and surrendered its pharmacy license.

What is Causing the Outbreak?

The primary causative organism is Exserohilum rostratum, a fungus typically found on plants and in the soil. It rarely causes disease in humans, and usually when it does infect humans it results in skin or sinus infections. This has made it difficult to provide precise information on when to expect symptoms to occur; the data are not available on fungal meningitis caused by E. rostratum. Continue reading

Of Mice and Cancer: How a relative of smallpox might help cure breast cancer

Vaccinia Virus, Source: Wikimedia Commons

Vaccinia Virus, Source: Wikimedia Commons

This post was originally published at Mind the Science Gap on Oct. 18, 2012.

Just in time for Breast Cancer Awareness Month, the American College of Surgeons issued a press release with a potentially  life-saving finding. Detailed in the press release are the results of a study recently conducted at Memorial Sloan Kettering Cancer Center (MSKCC) where scientists recently conducted a study in mice and found that a new vaccinia virus (named GLV-1h164) can kill Triple Negative Breast Cancer (TNBC) cells.

Vaccinia is a poxvirus, and it is in the same family as smallpox and monkeypox. In fact, vaccinia is the virus used in the smallpox vaccine. The virus in this study works by preventing the tumor from recruiting blood vessels (angiogenesis), a crucial step in cancer spreading. If a tumor can’t recruit blood vessels, then it can’t receive oxygen and nutrients from the blood. This virus effectively starves the tumor.

The Triple Negative of TNBC refers to breast cancers that do not express genes (a process where information from genes is turned into an actual product like a protein) for:

  1. Estrogen receptors – The status of these receptors determines a tumor’s susceptibility to hormonal chemotherapy drugs like tamoxifen. If receptors are present, hormonal treatments can be used in treatment.
  2. Progesterone Receptors – Like estrogen receptors, presence of these receptors indicates a tumor’s susceptibility to hormonal treatments
  3. Human Epidermal Growth Factor Receptor 2 or HER2 – A common target for cancer treatments, since HER2 overexpression leads to aggressive cancers Continue reading

Eastern Equine Encephalitis: The Mosquito that bit the Snake

A Copperhead. (C) Greg Hul, Flickr Creative Commons

This post was originally published at Mind the Science Gap on Oct. 11, 2012. This post was also cross-posted at Aetiology on Oct. 17, 2012.

Last week a new study regarding Eastern Equine Encephalitis (EEE) was published online (Bingham et.al.). EEE is a mosquito-borne virus that can cause serious, and sometimes deadly, disease in humans and equines. In warmer parts of North America, the virus is spread year-round, but in areas where mosquitoes get killed off in the winter it has been something of a mystery as to how the virus makes it from year to year. Humans and equines are both dead-end hosts, which means that a mosquito can not be infected from biting an infected person or horse. Researchers in Alabama found that wild snakes in the Tuskegee National Forest were positive for  Eastern Equine Encephalitis virus (EEEV), which could explain how EEE was maintained after the first frosts killed off infected mosquitoes. Essentially, what would happen is that an infected mosquito bites a snake, probably during the summer or early fall, and the snake harbors the virus in its blood during the winter. Then, in the spring, an uninfected mosquito (which overwinters as a larva) bites the snake and acquires the virus. This now-infected mosquito can bite a horse or a human, who can then get sick. (I’m sensing a Chad Gadya theme here. Just me? Ok…) Continue reading