Maryn McKenna

Journalist and Author

Scathing Report: Polio Eradication "Not… Any Time Soon"

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An independent monitoring board convened by the worldwide polio-eradication initiative has delivered a report on the global effort that is striking for its brutally frank and even frustrated tone.

Among its findings, just in its first few pages: “Case numbers are rising”; “unwelcome surprises continue”; “as many milestones are being missed as are being met”; and “the (eradication) Programme is not on track for its end-2012 goal, or for any time soon after unless fundamental problems are tackled.”

Possibly the biggest problem, the board concludes, is a get-it-done optimism so ingrained in the 23-year effort that it cannot acknowledge when things are not working:

We have observed that the Programme:

Is not wholly open to critical voices, perceiving them as too negative – despite the fact that they may be reporting important information from which the Programme could benefit.

Tends to believe that observed dysfunctions are confined to the particular geography in which they occur, rather than being indicative of broader systemic problems.

Displays nervousness in openly discussing difficult or negative items.

If some of this sounds familiar, that is because the board hit similar notes in its last report in July, in which it declared that the international effort “is not on track to interrupt polio transmission as it planned to do by the end of 2012.” I get the sense, reading the latest, that the board does not believe it was heard.

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25 Dead From Melons: FDA Points to Packing Facility

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Federal health authorities have determined responsibility for the vast 26-state outbreak of Listeria in cantaloupes, almost three months  — and 123 illnesses, 25 deaths and one miscarriage —  since it began.

In a long report released this week, they say they found Listeria not in the fields where the melons were grown, but in the packing and cold storage facilities on the single large farm where they all came from; and, in addition, they identified some practices on the farm that may have caused Listeria contamination or allowed it to multiply.

Just as a reminder of what was at stake here since we last talked about it: This is the first time that Listeria was found on cantaloupe in the United States, meaning there wasn’t a lot of past science to draw on. And this was a huge outbreak: The farm had 480 acres in cantaloupe, and shipped more than 300,000 cases of it. The number of fruit involved, according to MSNBC.com, may have been as high as 4 million.

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NDM-1 in India: Drug Resistance, Political Resistance

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It’s been more than a year since the “Indian superbug” NDM-1 — not actually a bacterium, but a gene that directs production of an enzyme — hit the news. The enzyme, whose acronym is short for New Delhi metallo-beta-lactamase-1, disables almost all antibiotics directed against it, leaving the bacteria in which the gene appears vulnerable to only two imperfect and sometimes toxic drugs.

The enzyme and its gene, blaNDM-1, were first identified in 2008 in people who had traveled in India or sought medical care in South Asia. Hence its name: Many beta-lactamases, enzymes that denature the very large class of everyday antibiotics known as beta-lactams, are named for countries and cities where they were first identified. Since its identification, NDM-1 has been discovered in patients in more than a dozen countries and has also been found to be widely harboured outside hospitals in India, and in surface waters and sewage there.

The unveiling of NDM-1 clearly caused embarrassment for India, and media and lawmakers there struck back, throwing around intemperate language and claiming the naming of the enzyme was a plot to derail the subcontinent’s medical-tourism industry — even though the Indian doctors had attempted to raise the alarm earlier and had been ignored.

So it seemed like a promising signal of openness when an international conference on antibiotic resistance opened in New Delhi a week ago. But in its wake, just what is going on in India — and whether its government is willing to face up to what might be an international crisis — is less clear than ever.

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Is China Banning Growth Promoters And Do They Mean It?

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A tantalizing prospect surfaced yesterday. The Institute for Agriculture and Trade Policy in Minneapolis tweeted a link to a Sept. 13 story from an online agricultural trade journal that said, in its entirety:

China’s Ministry of Agriculture has announced a forthcoming ban on antibiotics as growth promoters in animal feed. The ban is supported by the academic community, which believes that without antibiotics in animal feed, the health of animals will be better promoted, microbes’ resistance to antibiotics will be lowered and food will become safer to eat. Recent statistics show that in 2006 China produced 210,000 tons of antibiotics, and 97,000 tons were added to animal feed. Today it is estimated that 400,000 tons are produced annually.

So, first: If this story is accurate, it would be huge news. But, second: The story lists no sources and is almost a month old; in that month, there has been no other major coverage of this decision that I can find — which means a responsible reporter (which I try to be) needs to do some digging rather than pushing the link along.

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Can Better Bathroom Design Combat Infections?

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Evolutionary biologist and graphic-design geek Colin Purrington (author of the fantastic taxonomy of lab-notebook inks) has an issue with bathrooms. Specifically, with bathrooms so badly designed that no one washes and dries their hands adequately, and then everyone is forced to touch a door handle in order to exit. He’s sufficiently exasperated that he not only blogged his annoyance, he came up with some public-health messaging to share the spleen: a set of signs formatted for printing onto large-scale Post-It sheets, suitable for guerrilla adornment of any door or a hot-air blower.

My pet peeve: bathroom doors hinged in a way that require people to touch the handle or knob to exit. I’m sure there are fire code reasons why architects specify for this, but it’s strange (remote risk of fire vs real risk of disease)…. Compounding the above problem is the fad of equipping bathrooms with only electric hand dryers (“Saves the environment!”). Because cheap hand dryers take about 3 minutes to dry hands, many people opt to just exit the bathroom without washing their hands. Or at least guys.… I don’t hang out in women’s restrooms that often. This means that the handle or knob is going to get a lot more use from hands that are coated in microbial nasties.

Is Purrington right in his denunciation of door handles, hot-air blowers and bathroom design as an engine of infection? I took a look: There’s a lot of research on germiest hazards in public places, and a little on better design. The answers seem to be: Maybe, Yes, and Yes.

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Terror and Bioterror: 9/11 to 10/4 (Part 4)

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This Tuesday, Oct. 4, marks the 10th anniversary of the announcement of the first deaths in the 2001 anthrax-letter attacks, the first successful, fatal bioterrorist attack in American history on American soil. The anthrax attacks were recognized in the midst of the grief and disquiet that swept the United States after the Sept. 11 World Trade Center attacks, and like those, they changed for good the US’s sense of its security and its role in the world.

The foot-soldiers of much of the government response to 9/11 and 10/4 were the Epidemic Intelligence Service, the rapid-reaction disease detectives of the Centers for Disease Control and Prevention. In recognition of the anniversaries of the two attacks, I’ve been running excerpts from my book Beating Back the Devil about the little-known, behind the scenes disaster response work performed by the disease-detective corps.

Beating Back the Devil was written in 2004. In 2008, the FBI acknowledged that for several years, it had incorrectly pursued a government scientist named Steven Hatfill as a “person of interest” in the letter attacks. That same year, another government scientist named Bruce Ivins committed suicide as the FBI was preparing to name him their chief suspect. But that did not bring the story to an end; as Wired‘s Noah Schachtman reported earlier this year, serious doubts remain about the FBI’s actions and Ivins’ role.

But in October 2001, all of that lay in the future. The CDC’s disease detectives were enmeshed in the aftermath of the World Trade Center bombings, and turning their attention to mysterious illnesses in Florida, New York, and Washington, DC.

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Cantaloupe Outbreak: 13 Dead, 18 States, More To Come

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I’ve been away at a couple of very interesting conferences — more on those soon — so I’m late to this story; on the other hand, the story hasn’t even peaked yet, and thus there’s plenty of time for us to catch up.

So: An outbreak of foodborne illness that appears to be spread by fresh cantaloupes has sickened 72 people so far, in 18 states, and 13 have died. According to investigators, the source of the contamination has not yet been found. And also, according to a media briefing today, the contaminated cantaloupes were also shipped overseas, to countries that investigators would not identify. And, as an extra bonus, the tally of cases and deaths is likely to keep rising, because the particular illness in this outbreak has an incubation period of up to two months.

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Terror and Bioterror: 9/11 to 10/4 (Part 3)

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Between Sept. 11 and Oct. 4, 2001, the United States was paralyzed by fear: First of terrorism, from the World Trade Center attacks, and then of bioterrorism, because so many government planners believed a biowarfare attack would follow a conventional one. They were right. In this ongoing excerpt from Beating Back the Devil, a history of the CDC’s Epidemic Intelligence Service, a team of young disease detectives fans out across New York City in the wake of Sept. 11, hunting for any signals of a bioterror epidemic and struggling to separate what they see from common illnesses and panicked false alarms. While they search, a victim of bioterror does turn up — but far from New York City, at the other end of the East Coast.
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Did Poor Vaccine Response Contribute to California's Whooping Cough Outbreak?

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Breaking news from the 51st ICAAC meeting in Chicago: Physicians from the Kaiser Permanente Medical Center in San Rafael, California say they have found an unexpected amount of pertussis — whooping cough — in pre-teen children who had received their mandatory school-entry vaccination booster at age 5 and should have been protected from the disease until about the time of their final childhood booster dose at age 12.

The physicians said case records suggest the vaccine may have protected children for less time than it was expected to. They speculate that the cases they recorded — along with additional cases that are likely to have occurred outside Kaiser’s  patient population — helped amplify California’s 9,000-person pertussis epidemic in 2010.

“The vast majority of these were fully-vaccinated children,” Dr. David Witt, the medical center’s chief of infectious diseases, said in a press briefing during the meeting. “That was the surprise.”

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Terror and Bioterror: 9/11 to 10/4 (Part 2)

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The Sept. 11, 2001 attacks on the World Trade Center permanently changed the landscape of New York City and the tenor of American society — and, at the same time, the jobs of the disease detectives of the Centers for Disease Control and Prevention, who are called the Epidemic Intelligence Service. The EIS started in 1951 out of fears that soldiers serving in the Korean War would unknowingly be exposed to biological weapons, and bring the organisms home to cause stateside epidemics. That prediction turned out to be unfounded, and over the decades, the EIS — and the rest of the US government — allowed concerns over bioterror to drift to the bottom of their priority list. Sept. 11 yanked that concern back the top of the list again. Oct. 4, 2001 — the day the first case in the anthrax attacks was announced — proved just how realistic a fear it was.

To mark the 10th anniversary of 9/11 and 10/4, I’m running excerpts from Chapter 12 of my book Beating Back the Devil, which tells the story of the EIS’s involvement in both disasters. Part 1 told their experience on Sept. 11. In this excerpt, it’s now Sept. 12. New York City is devastated, US airspace is shut down, and the CDC is struggling with whom to deploy, and how.
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Big News But: USDA Bans "Other" E. coli Strains

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Good news, but not excellent news, today from the US Department of Agriculture: It has agreed that, starting in March 2012, six more strains of E. coli will be considered “adulterants,” putting them in the same regulatory category as the much-feared E. coli O157:H7.

It is a big step, to do this. Those six bacterial bad actors — technically, E. coli O26, O45, O103, O111, O121, and O145 — are now responsible for the majority of foodborne illness caused by E.coli in the United States, causing almost twice as much illness each year as O157 does.

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Terror and Bioterror: 9/11 to 10/4 (Part 1)

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Today, of course, marks the 10th anniversary of the attack on the World Trade Center. Everyone old enough to remember it has a story of that day. Here’s mine: I was on my way to work as a newspaper reporter. I heard the news, turned my car around, gave my cat extra food, and picked up spare clothes and flat shoes. Later, I heard that two of my cousins, and two acquaintances, were missing. By dusk, I learned my cousins had walked across a bridge into Queens, part of an ash-covered tide of refugees. By midnight, I knew my acquaintances were dead.

So let me tell you, instead, some other peoples’ stories of that day and what came after: the terrorism first, and then the fears of a bioterror attack to follow; the relief when no epidemic appeared, and then the sinking shock when it did. The disease detectives of the Centers for Disease Control and Prevention were at the center of that month of horror and confusion. Between now and Oct. 4, the 10th anniversary of the announcement of the anthrax attacks, I’ll run excerpts from Chapter 12 of my book Beating Back the Devil, about the disease detectives — the Epidemic Intelligence Service — of the CDC.

We begin in Atlanta, on the morning of Sept. 11, 2001.

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Q&A With Contagion's Science Advisor (Plus Spoilers!)

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If you are a disease geek, then yes, you will love Contagion, the all-star Oh God Oh God We’re All Going To Die movie that opened last night. Paramyxovirus! R-nought! BSL-4! And, bonus, so many insider references to the CDC that the script could double as an epidemiology drinking game. (Go to the end of this post for my fact-check of CDC references. They’re spoilery and thus hidden on the next page.)

To me, the fascinating thing about Contagion is how seriously it takes its epidemiology, its virology and even its sober sense of how unprepared most Americans are for a mass-casualty disaster (as captured in this April report from the National Biosurveillance Advisory Committee).

To find out where those came from, I asked its chief science adviser: Dr. W. Ian Lipkin, who is the John Snow Professor of Epidemiology, and Director of the Center for Infection and Immunity, at Columbia University’s Mailman School of Public Health, dubbed a “master virus-hunter” by master science-writer Carl Zimmer in the New York Times. Here’s our email Q & A.

Maryn: Given past “science” movies — Outbreak, for instance — I was surprised that the science in this movie is so solid. Was this your doing, and how did you manage it?

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Dangerous and Sad: Rising Suicides by Chemical Fumes

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There’s a lot of debate among journalists regarding whether we should publish stories about suicide. On the one hand, not publishing them is viewed as following an outdated taboo and depriving families of public attention to a loved one’s memory. On the other, there’s worry that seeing a story about suicide may give dark inspiration to someone whose emotional state is already on the brink.

So I confess, I have some hesitancy in talking about a bulletin published Thursday evening by the Centers for Disease Control and Prevention. They did it, not only to document a public health trend, but to highlight a real danger to first responders. That seems to me a legitimate concern — and since first responders have been a big part of stories I have covered over years, I’m going to publish it too.

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Tick-Borne Infections Infiltrate U.S. Blood Supply

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Allow me a tiny I Told You So. In February, I wrote a story for SELF Magazine about the rising incidence of diseases other than Lyme that are caused by tick bites. (And told you about it here, of course.) The story highlighted one particular tick-borne parasite, Babesia, and a serious problem with the infection it causes, babesiosis: that it was moving into the blood supply. We dug through FDA transcripts and CDC field reports in order to reveal that federal health authorities were very concerned about this prospect, and that more than 100 babesiosis infections caused by transfusions had already occurred — not just in the few states  where the tick species carrying Babesia are found, but throughout the United States because blood products are shipped nationwide.

Ours was the first reporting we could find about babesiosis in the blood supply, and it didn’t get the attention it should have, probably because women’s magazines tend to be dismissed as not-serious — even though SELF’s health and medical reporting has won prizes and been turned into books. But based on research released this morning, our story at SELF wasn’t hyping the problem. If anything, we understated it.

OK, enough infomercial. Here’s the news: In a paper released ahead-of-print by the Annals of Internal Medicine, researchers from the Centers for Disease Control and Prevention, Rhode Island and New York State report that 159 cases of babesiosis were caused by transfusions in the past 30 years  and “the risk may be increasing.” Twenty-seven of the patients died.

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Antibiotic Prescribing to Kids — Down, But Still Too Much

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In the CDC’s weekly bulletin today, there’s a report: 58 percent of the antibiotic prescriptions given to kids and pre-teens during medical office visits are for conditions for which antibiotics are not necessary.

And that’s an improvement.

It’s a sign of how difficult it has become to change the trend of over-use of antibiotics in human medicine, which — along with overuse in agriculture — is one of the main drivers of the emergence of antibiotic resistance worldwide.

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Brief Promo: Superbug is at The Open Notebook

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I’m flattered to say that I’m the latest guest at the excellent site The Open Notebook, where veteran science writers Jeanne Erdmann and Siri Carpenter run deep-dive interviews with writers, bloggers and journalists about what underlies their stories.

We talk about how I got on the scary-disease beat, what journals I read, how I organize my materials — and what the emotional costs of this work are.

As bonuses, we’ve got a copy of my original pitch for The Enemy Within, my April 2011 Scientific American story on multi-drug resistance in Gram-negative bacteria; screenshots of some of the programs I use to keep track of my stuff; and — by far my favorite — a Soundslides of pictures I’ve taken in the field, overlaid with audio of me giving tips and telling stories. (It’s the first time Open Notebook has done multimedia, and we’re pretty excited about it.)

The Open Notebook is a fantastic resource; great science writers including my WiSci blog-sibling David Dobbs, Carl Zimmer, Robin Marantz Henig and Steve Silberman have all unpacked their stories there. I hope you’ll take a look.

Borders are Irrelevant: Polio Returns to China

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Very bad news from China, as reported by Xinhua and confirmed by the World Health Organization: For the first time in 12 years, polio paralysis has surfaced in China. Four children, the oldest 2 years old, were diagnosed with polio in mid-July. They all live in Hotan prefecture in Xinjiang province (by weird coincidence, also the site of the latest Chinese food-safety scandal).

The generally accepted math, in polio detection, is that one verified case of polio paralysis represents up to 200 cases of silent infection. Those 200 undetected cases may not experience symptoms, but they can pass on the disease to others. As a result, one case of polio in an area that has been considered polio-free is an emergency. Four cases, as you can imagine, is much worse. [Read more…]

Drug Shortages: Endangering Human Lives and Pets, Too

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198.

That’s how many critically needed antibiotics, cancer drugs, diuretics, sedatives, stimulants and vaccines — among other drug categories — currently are in short supply in the United States. If you print out the list, which is maintained by the American Society of Health System Pharmacists, it runs to seven pages.

Back in February, I wrote in the Annals of Emergency Medicine, and also here at this blog, about ongoing shortages of critical drugs, and how physicians were beginning to worry about them. At the time, the list of drugs in short supply was up to about 140. [Read more…]