Maryn McKenna

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Found: Forgotten Vials of Smallpox

July 8, 2014 By Maryn Leave a Comment

Variola, CDC

Variola, CDC

Headline-making news today from the Centers for Disease Control and Prevention: Workers clearing out an old storage room on the Bethesda, Md. campus of the National Institutes of Health have found a forgotten box of vials that contain smallpox.

Yes, smallpox. The “most terrible of all the ministers of death,” as Thomas Babington Macaulay called it in his 1848 History of England — a disease that was the world’s most dreadful killer, until it was declared eradicated in 1980. A disease caused by a virus that now is supposed to reside in only two highly secure laboratories on the planet, in Russia, and at the CDC.

Smallpox is the only human disease ever successfully eradicated — pursued to elimination by a relentless dragnet that closed nooses of vaccination around every identified case. After the last natural infection, in Somalia in 1977, the World Health Organization launched a second dragnet, scouring lab freezers and storage rooms for any remaining samples of the virus, and consolidating them in Siberia and Atlanta.

Somehow, these six tubes of freeze-dried virus evaded the search. They were found in the storage room of a lab that now belongs to the Food and Drug Administration but was ceded to that agency by NIH in 1972. They may date back to the 1950s.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, FDA, NIH, smallpox, Who

Government Leadership on Antibiotic Resistance — in Europe

July 3, 2014 By Maryn Leave a Comment

Iqbal Osman (CC), Flickr

Iqbal Osman (CC), Flickr

A few pieces of news relative to antibiotic resistance caught my eye over the past few days. What they all had in common: Highly placed politicians stating unambiguously that antibiotic resistance should be a national and international priority.

This is superb, with just one catch: The politicians were in Europe.

The politicians speaking out were Prime Minister David Cameron in the United Kingdom, and Edith Ingeborg Schippers, Minister for Health, Education and Welfare, in the Netherlands. The leader of one government and a Cabinet-level minister in another — I can’t think of any occasion where US government officials of equal status have spoken out on the problem. In the United States, articulating the government position on resistance has been left to Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention. He is a very direct and thoughtful spokesman, but in the government’s organizational chart, he is one step below Schippers’ counterpart, the Secretary of Health and Human Services (Sylvia Mathews Burwell, sworn in last month), and several below Cameron’s counterpart, President Barack Obama.

Imagine Obama speaking out about antibiotic resistance. What a powerful statement of priorities that would be.

[Read more…]

Filed Under: Science, Science Blogs, Superbug

Enhancing Flu In the Lab: Are Accidents Inevitable?

June 30, 2014 By Maryn Leave a Comment

Image: Shane Byrd (CC), Flickr

Image: Shane Byrd (CC), Flickr

I want to revisit something I wrote about last month — dual-use or gain-of-function flu research — in order to point you to some important recent writing on the issue. To recap, “gain of function” research involves taking a flu strain that already causes severe disease, but is not currently very infectious, and manipulating it in the lab so that it  becomes more infectious. This project is being pursued by two high-profile flu labs, one in the Netherlands and one in Wisconsin, as well as some other smaller labs, and it has been criticized by other researchers as irresponsibly dangerous.

Most of the discussion over this practice has occurred in medical journals. But now one of the critics, Marc Lipsitch of Harvard, has written an op-ed for the New York Times that lays out the questions in everyday language. Lipsitch takes the recent lab error at the Centers for Disease Control and Prevention, which put about 80 employees at risk of inhaling live anthrax bacteria, as evidence that even the most careful, most secure labs make mistakes — and explains how deadly a lab mistake involving an enhanced flu could be.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: influenza

CDC: Traveling for Business Can Be An Expensive Health Risk

June 27, 2014 By Maryn Leave a Comment

The CDC Foundation, which supports the US Centers for Disease Control and Prevention, has put up a new publication urging business travelers to protect their health when they travel internationally and steering them to resources to help.

It’s a smart idea backed by some eye-opening statistics:

  • Cost of a course of malaria prophylaxis drugs: $162. Cost of being hospitalized with malaria on return: $25,250.
  • Cost of taking the two-dose hepatitis A vaccine: $300. Cost of treatment for a case of hep A: $2,500.
  • Cost of medical evacuation insurance: $370. Cost of a medical emergency evacuation: up to $250,000.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Business, CDC, Travel

A World Cup Visitor: Polio from Africa in Brazil

June 25, 2014 By Maryn Leave a Comment

Eutroph-outflow

Gerick Bergsma via Eutrophication & Hypoxia / Flickr

Unnerving news from Brazil, now hosting travelers from all over the world because of the World Cup: The virus that causes polio has been found in sewage in one of the cities where matches are being played.

The World Health Organization, which announced the finding on Monday, says the virus was discovered last week in a sample collected in March at Viracopos International Airport in Campinas, which is about 60 miles outside Sao Paulo, and is where many of the World Cup teams have been landing. The agency said no cases of polio have been identified and there is no evidence the disease has been transmitted.

Genetic sequencing of the virus—the WHO didn’t say, but probably done by the Centers for Disease Control and Prevention in Atlanta—revealed that it was closely related to a poliovirus that recently caused a case of the disease in Equatorial Guinea in West Africa. Humans are polio’s only host; so that probably means the virus was carried into Brazil by a traveler, likely someone who never knew he was harboring it.

Brazil, like most of the rest of the world, continues to vaccinate against polio, even though there have been no cases of polio in Brazil since 1989, and the Americas were declared polio-free in 1991. The high vaccination rate — 95 percent of children nationwide, and higher than that in Sao Paulo State — kept the  virus from spreading.

Still: not good.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: brazil, CDC, polio, Who

"Individual Actions Are Doomed to Failure": Coalition Asks for Global Action on Antibiotics

June 24, 2014 By Maryn Leave a Comment

antibiotics-inline

Biology101.org/Flickr

A newly formed international organization — more than 700 members in 55 countries — has launched an urgent appeal to governments and healthcare, begging for attention to antibiotic resistance as a grave global threat, and asking that antibiotics be declared a cultural heritage deserving legal protection.

The group grew out of meetings by French and other European researchers, and all its materials are bilingual, to the point that it is going by two names and acronyms: the World Alliance Against Antibiotic Resistance (WAAAR) and L’alliance contre le développement des bactéries multi-résistantes (AC2BMR).

The group has been in formation a while but went public Monday, publishing its appeal and asking for 10 specific actions to keep antibiotic resistance from surging beyond the point at which it can be controlled.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, Resistance

U.S. Travelers Return Home With Tropical Disease. Will It Spread in the States?

June 19, 2014 By Maryn Leave a Comment

NatureGirl78 (CC), Flickr

NatureGirl78 (CC), Flickr

If you happened to be reading state health departments’ outbreak announcements this past weekend, you might have seen something interesting.

(You don’t do this? Hmm.)

Three states — Rhode Island, North Carolina and Tennessee — all said that they have identified residents who have been diagnosed with the mosquito-borne tropical disease chikungunya. The states said all the victims had recently returned from the Caribbean, where the severe, painful illness has been spreading since late last year.

People in three states, all having visited the same place, all with the same illness: As a faithful armchair-epidemiologist, I couldn’t help but wonder whether they were linked in some manner, perhaps by a cruise or a church trip. As it turns out, the victims announced last weekend represent something more subtle and potentially more troubling: an increasing number of US residents acquiring the disease abroad and returning to the US with it — and posing the question of whether it will spread to mosquitos, and then to other humans, within this country’s borders.

What do I mean by “increasing”? This, for instance. The Centers for Disease Control and Prevention report chikungunya among US residents weekly on their website. Last week, the count for this year was 39. On Tuesday, it doubled, to 80.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, dengue

Very Serious Superbugs in Imported Seafood

June 11, 2014 By Maryn Leave a Comment

Image: Matsuyuki, Flickr

Image: Matsuyuki/ Flickr

Breaking news today from the Centers for Disease Control and Prevention, out of its open-access journal Emerging Infectious Diseases: Researchers in Canada have identified a very highly resistant bacterium in squid imported from South Korea and being sold in a Chinese grocery store.

The letter reporting the finding was supposed to go live at noon ET, but hasn’t yet. When it does, it will be linked from this page, under the subheading Letters. It is titled: “Carbapenamase-Producing Organism in Food, 2014.”

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, CDC, food policy, food safety, NDM, NDM-1, Resistance

What Are the Odds That an Artificially Enhanced Flu Strain Could Escape a Lab?

May 27, 2014 By Maryn Leave a Comment

Image: Shane Byrd (CC), Flickr

Image: Shane Byrd (CC), Flickr

A controversy that has been brewing for several years in the world of influenza research may ignite again with the publication last week of a new paper that’s worth a read. I haven’t to date written about the controversy, which centers on what’s called “gain of function” research. In the case of flu, what is being gained (via lab manipulation) is the ability for flu to transmit easily from one lab animal to another. The strains being manipulated are already virulent, that is, causing severe illness; and novel — that is, humans have never experienced them before, and so have no immunity to them. Adding transmissible to virulent and novel brings flu into the territory of becoming a potential pandemic strain. That’s where the controversy is, and what this new paper addresses.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: H5N1, H7N9, influenza

World Health Organization Drafting Global Plan on Drug Resistance. Is That Enough?

May 26, 2014 By Maryn Leave a Comment

NathanReading-staph

Image: Nathan Reading (CC), Flickr

The annual World Health Assembly — the meeting of representatives of the 194 countries that belong to the World Health Organization — ended Saturday. Each year, the Assembly defines policy and sets out goals for the coming 12 months in a series of voted-on resolutions. This year it zeroed in on antibiotic resistance, upping the ante on the WHO’s previous efforts to fight the emergence of resistance globally. The biggest initiative: A global action plan that the agency expects to have drafted by next January, in order to have it approved by all the levels of the organization so that it can be voted on next May.
[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Resistance, Who

CIA: In Future, We Won't Derail Major International Public Health Efforts. (Thanks?)

May 20, 2014 By Maryn Leave a Comment

Image: Julian Harneis (CC), Flickr

There’s news out this week that feels almost impossible to deliver without an eyeroll: The CIA has promised that it will “never again” use an international vaccination campaign as a cover for intelligence gathering.

I can’t see why not. I mean, the last attempt ended so well.

(Yes, that was sarcasm.)

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CIA, Osama bin Laden, Pakistan, polio, Taliban, WTF

Denmark: Three Deaths from Drug-Resistant "Pig MRSA"

May 12, 2014 By Maryn Leave a Comment

ICStefanescu (CC), Flickr

Image: ICStefanescu (CC), Flickr

A troubling and also kind of odd story came out of Denmark this weekend. In a court proceeding, a microbiologist has disclosed that three residents of the country who had no known connection to farming died of MRSA infections caused by ST398, the livestock-associated strain of drug-resistant staph that first appeared among pig farmers in the Netherlands in 2004 and has since moved through Europe, Canada and the United States.

If the report is correct — and sources have told me it is, but I’ve seen no data to confirm it — it reinforces the concern that bacteria which become resistant because of antibiotic use on farms can move off farms and affect the health of people who have no connection to farming.

Livestock MRSA has always one of the best cases for establishing that, because the drug to which it showed the greatest resistance, tetracycline, wasn’t used against human MRSA in the Netherlands, but was used routinely on farms — so the only place the strain could have picked up its unique resistance pattern was in pigs. (Here’s my long archive of posts on pig MRSA, dating back to my book Superbug where the story was told for the first time.)
[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, antibiotics, Denmark, food policy, food safety, MRSA, netherlands, Resistance, ST398

Polio Declared An International Health Emergency

May 6, 2014 By Maryn Leave a Comment

Prefvotuporanga (CC), Flickr

Image: André Luiz D. Takahashi (CC), Flickr

In a move that is simultaneously discouraging, urgent and deeply unusual, the World Health Organization has declared that the resurgence of polio is a “public health emergency of international concern.” It’s an extraordinary statement, coming less than four months after India — once considered a place where polio might never be vanquished — was declared polio-free after three years without a new case.

That achievement left only Afghanistan, Nigeria and Pakistan as countries where the chain of polio transmission had never been broken. But as the virus persists in those countries, it is also moving out across their borders. Seven other nations that previously had beaten polio — Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia and Syria — have now been reinfected, and the virus is spreading in communities there.

If the continued existence of polio is news to you, you’re not alone. It’s a largely forgotten disease in the industrialized West; the last United States case occurred in 1979. The WHO, the Centers for Disease Control and Prevention, the fraternal organization Rotary International and a raft of partners have been pressing an international and very expensive eradication campaign since 1988. Every time the world has gotten close, though, polio has flared up again. The WHO once thought it would be able to declare the disease eradicated in 2000; then it set 2005 as a target; then 2008; 2012; 2015; and now, a hoped-for 2018. (Here’s my archive of posts.)

But the past couple of months have thrown even that into doubt. The trigger for the WHO’s action was the discovery that there have been 74 cases of polio so far this year. That seems like a low number, but there were only 417 in all of 2013. And, crucially, winter is considered polio’s “low season” — so for polio to be spreading now rings an alarm bell for the warmer, wetter months when it usually spreads faster and further.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, CIA, Pakistan, polio, Who

World Health Organization: Antibiotic Resistance Grave Global Problem

May 5, 2014 By Maryn Leave a Comment

NathanReading-staph

Image: Nathan Reading (CC), Flickr

The World Health Organization has released a significant report marking what I think must be the first attempt to quantify antibiotic resistance globally. It’s a very sobering read — not just for what the data says about the advance of resistance worldwide, but also because of what the organization could not say, because the data doesn’t exist.

The numbers themselves are unsettling. Dr. Keiji Fukuda, the WHO’s assistant director general, told the press: “It’s clear that rates are very high of resistance among bacteria causing many of the most common serious infections – the ones that we see both occurring in the community as well as in hospitals … In all regions of the world, we now see that hospitals are reporting untreatable, or nearly untreatable, infections.”

But the gaps in the numbers are too: There are 194 member countries in the WHO, but only 114 had the data-gathering resources to contribute something to the report, and only 22 were able to send in data on the most important occurrences of resistance in very common bacteria. Thus it’s possible that the report could be an under-estimate, or an over-estimate. But I can’t think of a scenario in which it could be considered substantially inaccurate. Its portrait of a world in which antibiotic resistance is advancing to grave proportions ought to be taken seriously.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, CRE, E. coli, gonorrhea, NDM, Resistance, Who

NDM: "A Great Challenge for the Future of Healthcare"

April 29, 2014 By Maryn Leave a Comment

Jason Scragz (CC), Flickr

Jason Scragz (CC), Flickr

A paper published this week reminded me to take a fresh look at NDM, the “Indian superbug” — actually a gene and enzyme — that got so much attention, including from me, in 2011. (Most of the posts are here.) Quick reminder: NDM surfaced in 2008 in Sweden, then was found in the United Kingdom, then in the United States and then elsewhere in the world. It had several distinctive qualities. It appeared in gut bacteria such as Klebsiella and E. coli, and caused infections when those bacteria escaped the gut and got elsewhere in the body. It rendered those bacteria not-vulnerable to almost all antibiotics, leaving so few drugs to use against it that medical personnel found it truly alarming. And it had strong links to South Asia: The first known patient was an Indian man living in Sweden who had gone home for a visit and been hospitalized; victims found later either had family links to India and Pakistan or had gotten medical care there, as medical tourists or because they were injured while traveling.

NDM (which stands for New Delhi metallo-beta-lactamase; it was originally NDM-1, but there are now at least seven variants) generated a lot of alarm at the time, with good reason. Its unusual resistance pattern made useless the last category of broad-spectrum, last-resort antibiotics, called carbapenems, that were still working reliably. Physicians treating patients who had infections involving NDM had to hunt among just a few remaining drugs that were still on the shelf because they were toxic or did not work reliably. Plus, because bacteria carrying the NDM resistance factor colonize the gut, the infection could be transported across borders and into hospitals without anyone noticing. With no symptoms showing, few hospitals would bother to check a patient (or a family member), especially since testing for gut bacteria is more complicated and intimate than, for instance, testing someone’s nostrils for MRSA.

By last year, NDM had mostly dropped out of the headlines, even though it was still moving across the globe (this 2013 paper details countries where it has been identified), and had also begun causing hospital outbreaks (for instance, this one in Denver in 2012). So the new paper I mentioned, written by staff from Public Health England and analyzing the first 250 patients with NDM in the UK, is a useful reminder of how formidable a microbiologic foe this can be.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CRE, NDM, NDM-1, Resistance

CDC: Foodborne Illness in the U.S. Not Getting Better

April 17, 2014 By Maryn Leave a Comment

AnotherPintPlease (CC), Flickr

Image: AnotherPintPlease (CC), Flickr

The Centers for Disease Control and Prevention today released their annual survey of foodborne illnesses in the United States, and the news is, well, not great. In the words of the press announcement they sent out to announce the data release: “limited progress.”

The survey — technically the Foodborne Diseases Active Surveillance Network, but usually known as FoodNet — doesn’t cover the entire US; it’s a representative sample drawn from 10 sites in nine states where the CDC already has arrangements with epidemiologists and laboratory personnel. Those 10 sites, most of them at state health departments, cover 48 million people, or about 15 percent of the US population. So among that slice, in 2013, there were:

  • 19,056 lab-confirmed foodborne illnesses,
  • 4,200 of which were severe enough to cause the person to be hospitalized,
  • and 80 of which caused the person’s death.

(For context, the CDC’s extrapolation of foodborne illness nationwide, made in 2011, was 48 million illnesses, 128,000 hospitalizations and 3,000 deaths.)

The agency compared the 2013 numbers against two sets of data, one set taken covering 2010-12 and the other 2006-08. Its summation, from its report in its weekly publication MMWR:

Compared with 2010–2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall. Since 2006–2008, the overall incidence has not changed significantly. More needs to be done.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, E. coli, FSIS, salmonella, USDA

Traveling Abroad? Careful What You Carry Back… In Your Guts

April 10, 2014 By Maryn Leave a Comment

Photo: Ariel Zamblich/WIRED

Photo: Ariel Zambelich/WIRED

If you do any kind of challenging travel — adventure travel, backpacking, even just going to less-developed parts of the world — you’ve probably evolved some sort of protective routine. You get shots, take your malaria medication, wash raw things before eating them and take a water filter for the bad places. (Please tell me you do this. Condoms, too.)

But a new study just published in EuroSurveillance, the peer-reviewed journal of Europe’s equivalent of the CDC, raises the possibility that even if you are doing the right thing, you could pick up some very nasty stuff while you’re abroad — and that what you bring back could endanger not only you, but others around you as well. A team of French researchers reports that healthy travelers who had no contact with foreign medical systems brought back extremely drug-resistant bacteria, probably just from drinking water, and that the bacteria persisted in their guts for at least two months after they came home.
[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, ECDC, EU, NDM

A Patient in Minnesota Has Lassa Hemorrhagic Fever. (Don't Panic.)

April 4, 2014 By Maryn Leave a Comment

Daliborlev (CC), FLickr

Daliborlev (CC), FLickr

News from the Minnesota Department of Public Health and the Centers for Disease Control and Prevention: A Minnesota traveler returning from Africa has been hospitalized with what the CDC confirms to be Lassa fever, a viral hemorrhagic fever that is often lumped together with Ebola hemorrhagic fever, though they are caused by different organisms.

Given the news from West Africa of the growing Ebola outbreak there — 127 cases including 83 deaths, according to the World Health Organization’s last posted update — I suspect there’s going to be some attention to this case, possibly even some alarm. So, switching from Scary Disease Girl to Scary Disease Killjoy (which is sort of like Phoenix becoming Dark Phoenix, only without any planets blowing up): The Minnesota department says there’s no sign the disease has spread. The CDC says it’s not even likely to have infected passengers on the same airplane.

And if you’re thinking, well, surely this has never happened before, a viral hemorrhagic fever coming to the US via airline: Actually, it’s happened seven times before. And no one caught Lassa from the infected travelers in any of those times — not from sitting next to them, not from living in the same house with them, not from having sex with them. It is a very bad disease. But it is not the threat we like to imagine.

(Sorry to spoil the fun.)

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, Ebola, minnesota, risk

Sneak Peek: What the White House is Thinking About Antibiotic Resistance

April 4, 2014 By Maryn Leave a Comment

e-Magine Art (CC), Flickr

e-Magine Art (CC), Flickr

The President’s Council of Advisors on Science and Technology (PCAST for short) is preparing a major report on the problem of antibiotic resistance. The report won’t be published for a few months, but today PCAST held one of its periodic meetings, and aired what it thinks the most important issues are going to be. For anyone who cares about our dwindling ability to fight infections, or the responsibilities of healthcare to curb antibiotic use, or the large role that agriculture plays in causing antibiotic resistance to emerge, its live webcast was a satisfying listen. (The webcast will be archived here but is not yet up.)

PCAST not only webcasts its meetings; it also runs live auto-transcription at the same time. Below is a partial text, which I screengrabbed as this morning’s meeting was going on, and edited for clarity and length. I found it interesting, and reassuring in the breadth of the policy issues being considered, particularly the attention paid to the role of agriculture — as well as the possibility of tech contributions to farm and hospital surveillance, and to drug innovation. It makes me very curious what the final report will say.

[Read more…]

Filed Under: Science, Science Blogs, Superbug

Farm-Drug Companies Agree to Antibiotics Ban. More of the Same, or Fresh Start?

March 28, 2014 By Maryn Leave a Comment

USDA Photos by Lance Cheung/Flickr

Big news in the realm of agricultural antibiotics: For the first time in almost 37 years of trying, the US Food and Drug Administration has achieved some control over the meat-industry practice of routinely giving antibiotics to livestock. The drawback: The control comes in the form of a voluntary commitment by veterinary drug manufacturers — and while the FDA maintains the voluntary program will work, there is widespread skepticism that the agency may be optimistic.

Here is what has happened; it takes a few steps to lay out. The FDA has been putting this voluntary program together for several years now, via two “Guidances” (numbered 209 and 213), which are nonbinding agency recommendations without the legal force of regulations, plus a Directive, which fills in the details. The three documents set forth what the agency wants to see happen: for meat production to stop using the routine micro-doses (“growth promoters” or “subtherapeutic antibiotics”) that fatten animals, but create antibiotic resistance; for farmers to stop administering antibiotics to entire herds or flocks via their feed and water; and for antibiotics to be used on farms only with the oversight of a licensed veterinarian. They accomplish that by asking veterinary antibiotics manufacturers to change the labeling on the drugs, so that they can no longer legally be sold over-the-counter to be used for growth promotion. The first Guidance, 209, was made final a year ago, and sets out the rationale for making this change. The second, 213, was made final last December; at that time, the FDA gave veterinary drug manufacturers  three months to say whether they were going to comply.

Which brings us to the new news: On Wednesday afternoon, the FDA’s Center for Veterinary Medicine published the list of veterinary drug manufacturers who have agreed to comply with the voluntary label change. Out of 26 manufacturers in that market, 25 agreed to cooperate. The FDA says this represents “99.6 percent of the applications,” that is, drugs and the ways they are administered.

So: Is the long battle over growth-promoter antibiotics, banned in Europe for 8 years now, over just like that? Or is there more to do?

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Science Blogs

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