Archive for the ‘CDC’ Category

Every one of us will die someday, but not necessarily in an interesting way. Courtesy of the Centers for Disease Control and Prevention, here’s a map you can use to figure out just what kind of unusual causes of death occur in your state.

The CDC recently released an infographic of the “most distinctive causes of death” in each of the 50 states. The peer-reviewed paper, which was published on the CDC’s website, details which cause of death in each state sticks out when compared to the national average. The authors write that the results, which used data from 2000 to 2010, were intended to give a “more nuanced view of mortality variation” across the country.

Because Kent Brantly is a physician who has watched people die of Ebola, there was an especially chilling prescience to his assessment last week, between labored breaths: “I am going to die.”

His condition was grave. But then on Saturday, we saw images of Brantly’s heroic return to U.S. soil, walking with minimal assistance from an ambulance into an isolation unit at Emory University Hospital.

“One of the doctors called it ‘miraculous,'” Dr. Sanjay Gupta reported from Emory this morning, of Brantly’s turnaround within hours of receiving a treatment delivered from the U.S. National Institutes of Health. “Not a term we scientists like to throw around.”

“The outbreak is moving faster than our efforts to control it,” Dr. Margaret Chan, director of the World Health Organization, said on Friday in a plea for international help containing the virus. “If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives, but also severe socioeconomic disruption and a high risk of spread to other countries.”

In that light, and because Ebola is notoriously incurable (and the strain at large its most lethal), it is overwhelming to hear that “Secret Serum Likely Saved Ebola Patients,” as we do this morning from Gupta’s every-20-minute CNN reports. He writes:

Three top secret, experimental vials stored at subzero temperatures were flown into Liberia last week in a last-ditch effort to save two American missionary workers [Dr. Kent Brantly and Nancy Writebol] who had contracted Ebola, according to a source familiar with details of the treatment.

Brantly had been working for the Christian aid organization Samaritan’s Purse as medical director of the Ebola Consolidation Case Management Center in Monrovia, Liberia. The group yesterday confirmed that he received a dose of an experimental serum before leaving the country.

In Gupta’s optimistic assessment, Brantly’s “near complete recovery” began within hours of receiving the treatment that “likely saved his life.” Writebol is also reportedly improved since receiving the treatment, known as zMapp. But to say that it was a secret implies a frigid American exceptionalism; that the people of West Africa are dying in droves while a classified cure lies in wait.

The “top-secret serum” is a monoclonal antibody. Administration of monoclonal antibodies is an increasingly common but time-tested approach to eradicating interlopers in the human body. In a basic monoclonal antibody paradigm, scientists infect animals (in this case mice) with a disease, the mice mount an immune response (antibodies to fight the disease), and then the scientists harvest those antibodies and give them to infected humans. It’s an especially promising area in cancer treatment.

In this case, the proprietary blend of three monoclonal antibodies known as zMapp had never been tested in humans. It had previously been tested in eight monkeys with Ebola who survived—though all received treatment within 48 hours of being infected. A monkey treated outside of that exposure window did not survive. That means very little is known about the safety and effectiveness of this treatment—so little that outside of extreme circumstances like this, it would not be legal to use. Gupta speculates that the FDA may have allowed it under the compassionate use exemption.

A small 2012 study of monoclonal antibody therapy against Ebola found that it was only effective when administered before or just after exposure to the virus. A 2013 study found that rhesus macaques given an antibody mix called MB-003 within the 48-hour window had a 43 percent chance of surviving—as opposed to their untreated counterparts, whose survival rate was zero.

This Ebola outbreak is the largest in the history of the disease, in terms of both cases and deaths, 729 887 known so far. As Chan warned in her call for urgent international action, the outbreak is geographically the largest, already in four countries with fluid population movement across porous borders and a demonstrated ability to spread by air travel. The outbreak will be stopped by strategic quarantines and preventive education, primarily proper handling of corpses. More than 60 aid workers have become infected, but many more will be needed to stem the tide.

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Disease (NIAID), is encouraged by the antibody treatment.

“Obviously there are plans and enthusiasm to expand this,” Fauci told me. “The limiting factor is the extraordinary paucity of treatment regimens.” Right now the total amount available, to Fauci’s knowledge, is three treatment courses (in addition to what was given to Brantly and Writebol).

NIAID did some of the original research that led to the development, but this is owned by Mapp Biopharmaceuticals. “They are certainly trying to scale up,” Fauci said, “but I’ve heard that their capability is such that it’s going to be months before they have a substantial number of doses, and even then they’re going to be limited.”

“We’re hearing that the administration of this cocktail of antibodies improved both Dr. Brantly and Ms. Writebol, but you know, we don’t know that,” Fauci said, noting the sample size (two) of this small, ad hoc study. Proving effectiveness would require a much larger group of patients being compared to an untreated group. “And we don’t know that they weren’t getting better anyway.”

Thanks to Kebmodee for bringing this to the attention of the It’s Interesting community.

http://www.theatlantic.com/health/archive/2014/08/the-secret-ebola-treatment/375525/

By ALAN SCHWARZ

More than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Center.

The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young.

The American Academy of Pediatrics standard practice guidelines for A.D.H.D. do not even address the diagnosis in children 3 and younger — let alone the use of such stimulant medications, because their safety and effectiveness have barely been explored in that age group. “It’s absolutely shocking, and it shouldn’t be happening,” said Anita Zervigon-Hakes, a children’s mental health consultant to the Carter Center. “People are just feeling around in the dark. We obviously don’t have our act together for little children.”

Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., said in a telephone interview: “People prescribing to 2-year-olds are just winging it. It is outside the standard of care, and they should be subject to malpractice if something goes wrong with a kid.”

Friday’s report was the latest to raise concerns about A.D.H.D. diagnoses and medications for American children beyond what many experts consider medically justified. Last year, a nationwide C.D.C. survey found that 11 percent of children ages 4 to 17 have received a diagnosis of the disorder, and that about one in five boys will get one during childhood.

A vast majority are put on medications such as methylphenidate (commonly known as Ritalin) or amphetamines like Adderall, which often calm a child’s hyperactivity and impulsivity but also carry risks for growth suppression, insomnia and hallucinations.

Only Adderall is approved by the Food and Drug Administration for children below age 6. However, because off-label use of methylphenidate in preschool children had produced some encouraging results, the most recent American Academy of Pediatrics guidelines authorized it in 4- and 5-year-olds — but only after formal training for parents and teachers to improve the child’s environment were unsuccessful.

Children below age 4 are not covered in those guidelines because hyperactivity and impulsivity are developmentally appropriate for toddlers, several experts said, and more time is needed to see if a disorder is truly present.

Susanna N. Visser, who oversees the C.D.C.’s research on the disorder, compiled Friday’s report through two sources: Medicaid claims in Georgia and claims by privately insured families nationwide kept by MarketScan, a research firm. Her report did not directly present a total number of toddlers 2 and 3 years old nationwide being medicated for the disorder, however her data suggested a number of at least 10,000 and perhaps many more.

Dr. Visser’s analysis of Georgia Medicaid claims found about one in 225 toddlers being medicated for A.D.H.D., or 760 cases in that state alone. Dr. Visser said that nationwide Medicaid data were not yet available, but Georgia’s rates of the disorder are very typical of the United States as a whole.

“If we applied Georgia’s rate to the number of toddlers on Medicaid nationwide, we would expect at least 10,000 of those to be on A.D.H.D. medication,” Dr. Visser said in an interview. She added that MarketScan data suggested that an additional 4,000 toddlers covered by private insurance were being medicated for the disorder.

Dr. Visser said that effective nonpharmacological treatments, such as teaching parents and day care workers to provide more structured environments for such children, were often ignored. “Families of toddlers with behavioral problems are coming to the doctor’s office for help, and the help they’re getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child,” Dr. Visser said. “It puts these children and their developing minds at risk, and their health is at risk.”

Very few scientific studies have examined the use of stimulant medications in young children. A prominent 2006 study found that methylphenidate could mollify A.D.H.D.-like symptoms in preschoolers, but only about a dozen 3-year-olds were included in the study, and no 2-year-olds. Most researchers on that study, sponsored by the National Institute of Mental Health, had significant financial ties to pharmaceutical companies that made A.D.H.D. medications.

Some doctors said in interviews on Friday that they understood the use of stimulant medication in 2- and 3-year-olds under rare circumstances.

Keith Conners, a psychologist and professor emeritus at Duke University who since the 1960s has been one of A.D.H.D.’s most prominent figures, said that he had occasionally recommended it when nothing else would calm a toddler who was a harm to himself or others.

Dr. Doris Greenberg, a behavioral pediatrician in Savannah, Ga., who attended Dr. Visser’s presentation, said that methylphenidate can be a last resort for situations that have become so stressful that the family could be destroyed. She cautioned, however, that there should not be 10,000 such cases in the United States a year.

“Some of these kids are having really legitimate problems,” Dr. Greenberg said. “But you also have overwhelmed parents who can’t cope and the doctor prescribes as a knee-jerk reaction. You have children with depression or anxiety who can present the same way, and these medications can just make those problems worse.”

Dr. Visser said she could offer no firm explanation for why she found toddlers covered by Medicaid to be medicated for the disorder far more often than those covered by private insurance.

Dr. Nancy Rappaport, a child psychiatrist and director of school-based programs at Cambridge Health Alliance outside Boston who specializes in underprivileged youth, said that some home environments can lead to behavior often mistaken for A.D.H.D., particularly in the youngest children.

“In acting out and being hard to control, they’re signaling the chaos in their environment,” Dr. Rappaport said. “Of course only some homes are like this — but if you have a family with domestic violence, drug or alcohol abuse, or a parent neglecting a 2-year-old, the kid might look impulsive or aggressive. And the parent might just want a quick fix, and the easiest thing to do is medicate. It’s a travesty.”

http://www.nytimes.com/2014/05/17/us/among-experts-scrutiny-of-attention-disorder-diagnoses-in-2-and-3-year-olds.html?partner=rss&emc=rss&smid=tw-nytimes&_r=1

heart infection

University of Iowa researchers have discovered what causes the lethal effects of staphylococcal infective endocarditis – a serious bacterial infection of heart valves that kills approximately 20,000 Americans each year. According to the UI study, the culprits are superantigens — toxins produced in large quantities by Staphylococcus aureus bacteria — which disrupt the immune system, turning it from friend to foe.

“The function of a superantigen is to ‘mess’ with the immune system,” says Patrick Schlievert, PhD, UI professor and chair of microbiology at the UI Carver College of Medicine. “Our study shows that in endocarditis, a superantigen is over-activating the immune system, and the excessive immune response is actually contributing very significantly to the destructive aspects of the disease, including capillary leakage, low blood pressure, shock, fever, destruction of the heart valves, and strokes that may occur in half of patients.”

Other superantigens include toxic shock syndrome toxin-1, which Schlievert identified in 1981 as the cause of toxic shock syndrome.

Staph bacteria is the most significant cause of serious infectious diseases in the United States, according to the Centers for Disease Control and Prevention (CDC), and infective endocarditis is the most serious complication of staph bloodstream infection. This dangerous condition affects approximately 40,000 people annually and has a death rate of about 50 percent. Among patients who survive the infection, approximately half will have a stroke due to the damage from the aggressive infection of the heart valves.

Despite the serious nature of this disease, little progress has been made over the past several decades in treating the deadly condition.

The new study, led Schlievert, and published Aug. 20 in the online open-access journal mBio, suggests that blocking the action of superantigens might provide a new approach for treating infective endocarditis.

“We have high affinity molecules that neutralize superantigens and we have previously shown in experimental animals that we can actually prevent strokes associated with endocarditis in animal models. Likewise, we have shown that we can vaccinate against the superantigens and prevent serious disease in animals,” Schlievert says.

“The idea is that either therapeutics or vaccination might be a strategy to block the harmful effects of the superantigens, which gives us the chance to do something about the most serious complications of staph infections.”

The UI scientists used a strain of methicillin resistant staph aureus (MRSA), which is a common cause of endocarditis in humans, in the study. They also tested versions of the bacteria that are unable to produce superantigens. By comparing the outcomes in the animal model of infection with these various bacteria, the team proved that the lethal effects of endocarditis and sepsis are caused by the large quantities of the superantigen staphylococcal enterotoxin C (SEC) produced by the staph bacteria.

The study found that SEC contributes to disease both through disruption of the immune system, causing excessive immune response to the infection and low blood pressure, and direct toxicity to the cells lining the heart.

Low blood flow at the infection site appears to be one of the consequences of the superantigen’s action. Increasing blood pressure by replacing fluids reduced the formation of so-called vegetations – plaque-like meshwork made up of cellular factors from the body and bacterial cells — on the heart valves and significantly protected the infected animals from endocarditis. The researchers speculate that increased blood flow may act to wash away the superantigen molecules or to prevent the bacteria from settling and accumulating on the heart valves.

In addition to Schlievert, the research team included Wilmara Salgado-Pabon, PhD, the first author on the study, Laura Breshears, Adam Spaulding, Joseph Merriman, Christopher Stach, Alexander Horswill, and Marnie Peterson.

The research was funded in part by grants from the National Institutes of Health (AI74283, AI57153, AI83211, and AI73366).

http://www.infectioncontroltoday.com/news/2013/08/bacterial-toxins-cause-deadly-heart-disease.aspx

MERS-CoV

Saudi Arabia reported today that five more people have been infected with the Middle East respiratory syndrome coronavirus (MERS-CoV), as if to underline yesterday’s warning from the head of the World Health Organization (WHO) that the novel virus is a global threat.

In a brief statement, the Saudi Ministry of Health (MOH) said, “Within the framework of the epidemiological surveillance of the novel Coronavirus (MERS-CoV), the Ministry of Health (MOH) has announced that five novel Coronavirus cases have been recorded among citizens in the Eastern Region, ranging in age from 73 to 85 years, but they have all chronic diseases.”

Also, two more deaths from MERS have been reported in the past few days. Yesterday Agence France Presse (AFP) reported the death of France’s first MERS-CoV patient, a 65-year-old man whose illness was first reported on May 8. And on May 26 the Saudi MOH announced the death of an 81-year-old woman.

With today’s Saudi announcement, the unofficial global case count has reached 49; the death toll stands at 24, according to the US Centers for Disease Control and Prevention (CDC). Unofficially, Saudi Arabia has had 37 cases, with 18 deaths.

WHO concern
Deep concern about MERS-CoV was expressed yesterday by WHO Director-General Margaret Chan, MD, MPH, as she closed the annual World Health Assembly (WHA), the WHO’s policy-making body.

“Looking at the overall global situation, my greatest concern right now is the novel coronavirus,” she said as quoted in a WHO press release. “We understand too little about this virus when viewed against the magnitude of its potential threat. Any new disease that is emerging faster than our understanding is never under control.

“These are alarm bells and we must respond. The novel coronavirus is not a problem that any single affected country can keep to itself or manage all by itself. The novel coronavirus is a threat to the entire world.”

The WHO plans to send a second team to Saudi Arabia in coming weeks to help investigate the mysterious virus, according to a May 25 Arab News story that quoted Chan. The source of the pathogen remains unknown, but several case clusters have shown that it can spread between people in close contact.

“Without that proper risk assessment, we cannot have clarity on the incubation period, on the signs and symptoms of the disease, on the proper clinical management and then, last but not least, on travel advice,” Chan told Arab News.

The WHO, which sent a group of experts to Saudi Arabia earlier this month, will provide a fresh risk assessment ahead of this year’s Haj pilgrimage, which will take place in October, the story said.

Details on deaths
Concerning the five new cases, the Saudi MOH left many questions unanswered, including whether the patients are part of a hospital-centered outbreak of MERS-CoV that began in April in the Al-Ahsa region of Eastern province. The cluster has been reported to include 22 cases with 10 deaths. The statement gave no information on the patients’ conditions, gender, where they live, or how long they have been sick.

The French patient who died became ill on Apr 23, six days after he returned home from a vacation in Dubai, United Arab Emirates. Another person contracted the virus after sharing a hospital room with him from Apr 27 to 29.

The 81-year-old Saudi woman who died was among the previously announced cases in Al-Ahsa governorate, the Saudi MOH said in a May 26 statement. It said she was suffering from chronic kidney failure and other chronic diseases.

Her case appears to be the one announced by the WHO on May 18. That announcement said the 81-year-old’s illness was the 22nd case in the hospital-centered cluster in Al-Ahsa.

The May 26 MOH statement also said that nine other case-patients have recovered and been discharged from hospitals since the first MERS-CoV in Saudi Arabia, which occurred in June 2012.

MERS-CoV designation

In other developments, the WHO announced today that it is accepting the name MERS-CoV for the novel virus, despite a general aversion to geographic references in the names of newly discovered viruses.

“Given the experience in previous international public health events, WHO generally prefers that virus names do not refer to the region or place of the initial detection of the virus,” the agency said in a statement. “This approach aims at minimizing unnecessary geographical discrimination that could be based on coincidental detection rather than on the true area of emergence of a virus.”

The name was proposed by the Coronavirus Study Group of the International Committee on Taxonomy of Viruses, the WHO noted. The statement said the term emerged from consultations with a large group of scientists and represents an acceptable consensus

Patent issues
Also today, a story in BMJ offered more details on intellectual property issues related to MERS-CoV. Albert Osterhaus, DVM, PhD, head of viriology at Erasmus Medical Center in the Netherlands, told the journal that Erasmus has applied for patents on MERS-CoV genetic sequences and on possible related products such as diagnostics and vaccines.

Erasmus scientists were the first to analyze the virus and identify it as novel last year, after an Egyptian physician working in Saudi Arabia sent them a sample. Last week Chan and Saudi officials complained that restrictions imposed by Erasmus on use of MERS-CoV samples that it has supplied to other labs were impeding the investigation of the outbreak.

Erasmus officials have rejected the criticism and said they have supplied samples to all labs that want to use it for public health research and are equipped to handle if safely. But Osterhaus told BMJ, “We have patent applications submitted and that is on the sequences and the possibilities to eventually make diagnostics, vaccines, antivirals, and the like. It’s quite a normal thing if you find something new to patent it.”

He added that Erasmus has not made a deal with any company yet, because it’s too early. “At the end of the day, if you want something to happen for the benefit of public health—including making a vaccine, antivirals, whatever—you need to have at least some intellectual property. Otherwise the companies will not be interested,” he said.

http://www.cidrap.umn.edu/cidrap/content/other/sars/news/may2813corona.html

 

 

 

If hantavirus wasn’t enough to freak you out, the Associated Press reported on Tuesday that the autopsy report for a 30-year-old man in southwestern Indiana indicates that a brain-eating amoeba was responsible for his death. If confirmed by the Centers for Disease Control and Prevention, this would be the fourth death this year from primary amebic meningoencephalitis, which is caused by a parasite known as Naegleria fowleri

Naegleria fowleri is a single-celled living organism that lives in warm, fresh water, according to the CDC. (It’s not actually an amoeba, despite the colloquial term for it.) It can travel up your nose while swimming in a lake or stream, multiply, and proceed to eat your brain. It has a 99 percent fatality rate, since only one person in the United States has ever been documented surviving the infection. (There have also been several incidents in the US in recent years of people getting the parasite from using a neti pot.) 

Still, it’s a rare occurrence—between 2002 and 2011, there were only 32 infections in the US. Four deaths in a year is well within the recent average.

But as the CDC points out, the organism “grows best at higher temperatures.” That might be a good reason to worry about whether higher temperatures caused by climate change will make it worse, as a CDC scientist warned a few years ago:

“This is definitely something we need to track,” said Michael Beach, a specialist in recreational waterborne illnesses for the Centers for Disease Control and Prevention.

“This is a heat-loving amoeba. As water temperatures go up, it does better,” Beach said. “In future decades, as temperatures rise, we’d expect to see more cases.”

The CDC notes that “assessing the potential for climate-related changes to the geographical range of the organism and associated infections” is one of the areas the agency is working on.

http://www.motherjones.com/blue-marble/2012/09/brain-eating-amoebas-climate-change

 

 

 

It started with fever, fatigue,  diarrhea and loss of appetite.

But for two farmers in northwestern Missouri, the severe illness that followed a tick bite led epidemiologists on a journey to a new viral discovery.

“It’s brand new to the world,” said William Nicholson with the National Center for Emerging and Zoonotic Infectious Disease at the U.S. Centers for Disease Control and Prevention.

“It’s unique in that it’s never been found elsewhere and it is the first phlebovirus found to cause illness in humans in the Western Hemisphere. At this point we don’t know how widespread it may be, or whether it’s found in other states. We don’t know how many people in Missouri may have had this virus, as the finding of a completely new virus was a surprise to us.”

Nicholson, one of the authors of the report detailing the two cases published Wednesday in The New England Journal of Medicine, suspects the new virus is a member of the tick-borne phlebovirus and is a distant cousin to Severe Fever with Thrombocytopenia Syndrome Virus (SFTSV), a virus found in central and northeastern China and known to cause death in 13 to 30% of patients.

There are more than 70 distinct viruses in the phlebovirus family, and they’re grouped according to whether they are carried and transmitted by sandflies, mosquitoes or ticks.

“We’re not saying at this point that it is tick-borne,” Nicholson said. “We suspect ticks. It might be a lone star tick or another tick, but we have not ruled out sandflies or mosquitoes.”

According to Nicholson, this new virus “clusters genetically” – or is very similar, yet distinct – to other tick-transmitted phleboviruses and more distantly with the sandfly and mosquitoes. Researchers identified it by genetically sequencing the entire genome of the virus and comparing it to existing viral genomes.

“We’re casting a wide net so we can really figure out where this virus is located and how it’s being transmitted,” he said. “We are also going to be doing laboratory studies to learn more about the biology of the virus and how it might be transmitted.”

One farmer was a healthy 57 year-old man; the other, a 67-year-old man with type II  diabetes. Recovery for both farmers was slow. Both were hospitalized for about two weeks in 2009, and took about a month and a half to recovery fully.

It’s unknown whether this new virus can be transmitted from person to person, but no family members or caregivers reported symptoms similar to either patient.

At the moment, Nicholson said, there is no cause for concern. “I don’t think anyone should be worried. We are not worried … we are curious of what role the virus plays in human disease.”

To that end, an epidemiological study is underway in western Missouri, where researchers hope to identify new patients with similar symptoms. For now, researchers will turn their attention to the large number of vertebrae hosts maintaining the virus in nature – mammals both wild and and domestic, as well as birds. In the fall, they will check out the deer and wild turkey population.

Tick-borne diseases are on the rise in the United States. And while this new disease might not be tick-borne, ticks are the number-one suspect. Nicholson says people should use repellent, check themselves for bites or ticks, and avoid certain areas – if possible – that might serve as good habitats for ticks, such as wooded areas and areas with fallen leaves.

http://thechart.blogs.cnn.com/2012/08/30/new-virus-found-in-missouri-ticks-suspected/?hpt=hp_bn12