Maryn McKenna

Journalist and Author

CDC: Pretty Much Everyone Is Fat

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The Centers for Disease Control and Prevention has released its latest mapping of obesity in the United States, based on data gathered by a CDC project known as BRFSS for the Behavioral Risk Factor Surveillance System. The BRFSS is a massive, continuous telephone survey of adults in U.S. states and territories, and every year it churns out high-quality information on a vast array of public health issues: smoking, heart disease, arthritis, asthma, immunization coverage, cancers, diet…. For anyone interested in health data, it’s a huge resource.

The current dive into the data for 2011 finds, unsurprisingly but depressingly, that a significant proportion of the U.S. population is obese. Not just overweight: obese. From the report:

[O]besity prevalence ranged from 20.7% in Colorado to 34.9% in Mississippi in 2011. No state had a prevalence of obesity less than 20%. 39 states had a prevalence of 25% or more; 12 of these states had a prevalence of 30% or more: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia.

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Resistant Gonorrhea: CDC Says Just One Drug Left

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Well, that didn’t take long.

Exactly 6 months after warning, in a major medical journal, that gonorrhea was becoming untreatable by the last two drugs commonly used against it, the Centers for Disease Control has taken one of those drugs off the table, leaving just one antibiotic available to treat the disease.

In a bulletin published today, the public health agency says that data from the national Gonococcal Isolate Surveillance Project shows a high enough percentage of resistance to the oral cephalosporin cefixime that “CDC no longer recommends cefixime at any dose as a first-line regimen for treatment of gonococcal infections.” Instead, it says, physicians should administer a single dose of injectable ceftriaxone, accompanied by some additional oral drugs.

This has been coming for a while, but it is still unnerving news. It means that the entire structure of sexually transmitted disease control in the United States — single doses of drugs given in single outpatient-clinic visits — now hangs on this one remaining drug. If ceftriaxone also becomes ineffective, then STD treatment will instead become a matter of giving drugs by IV: slower, more complicated, more expensive, and likely more difficult to access.

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Is Childhood Pertussis Vaccine Less Effective Than We Thought?

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Delicately and cautiously, health authorities in the United States and other countries are beginning to open up a difficult topic: Whether the extraordinary ongoing epidemic of whooping cough, the worst in more than 50 years, may be due in part to unexpected poor performance by the vaccine meant to prevent the disease.

That possibility, captured in several recent pieces of research — one published last night — is being raised so carefully because it might lead vaccine opponents to claim incorrectly that pertussis vaccination does not work. That fear contains a deep irony: The current vaccine, in use for about 20 years, replaced an older and more effective one that went out of use because vaccine critics charged it had too high a rate of side effects.

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CDC: Superbug NDM-1 Spreads Within a US Hospital

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Last night, prompted by Michael Coston’s excellent primer on NDM-1 (one of a set of short courses he publishes periodically), I scrolled through the literature to see what had happened recently with the spread of the “Indian superbug” — actually a gene and enzyme that were first spotted in 2008 and create resistance to almost all antibiotics. (My past posts on NDM-1, going back several years, are here.)

There was a lot to see: Cases in countries as varied as Belgium, Japan, Oman, Singapore and China. Indications that transmission of NDM-1, which at first indicated some travel or family connection to South Asia, has become a pan-European problem with clusters in several countries. Concern that international travelers are transporting bacteria containing the gene without realizing it. And, disappointingly, reassurances from within India, in a new study, that it can “easily combat” NDM-1 — though the fact that a study was conducted, as opposed to the problem just being denied out of existence, must be an encouraging sign.

That tour through the literature made me curious what has been happening in the United States since NDM-1 was first identified in patients here two years ago this week, and I made a note to check when I got back to work today. And then the Centers for Disease Control and Prevention forestalled me, by announcing this morning that there have been 13 cases in the United States so far — including two in which the infection apparently spread within the same hospital.

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Drug-Resistant Gonorrhea: WHO Agrees It's An Emergency

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Image: KaptainKobold/Flickr

The World Health Organization has weighed in on the growing threat from antibiotic-resistant gonorrhea, saying in a statement this morning (emailed, and apparently not online):

Millions of people with gonorrhoea may be at risk of running out of treatment options unless urgent action is taken, according to the World Health Organization (WHO). Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics — the last treatment option against gonorrhoea. Every year an estimated 106 million people are infected.

The statement arrived as an adjunct to the launch of the WHO’s new global action plan for controlling the spread of resistant gonorrhea.

If you’ve been reading here for a while, the problem of resistant gonorrhea won’t be new to you. (Here are some past posts on data from the CDC and a call to action in the New England Journal of Medicine, along with a piece I wrote in Scientific American and a separate post by my SciAm editor Christine Gorman.) But in case you’ve just come in:

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Drug-Resistant Gonorrhea: How We Lost Track

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if I were starting this blog today, I’d be tempted to name it the Department of Unintended Consequences. So much of what I write about seems to belong in that zone: Send U.N. troops to Haiti, start a cholera epidemic. Aim to eradicate wild polio, clear the way for the vaccine-derived kind. Drive down the price of producing animal protein, ramp up antibiotic resistance.

Now add to the list: Develop cheap rapid tests for detecting sexually transmitted diseases, and lose the ability to track that those diseases are becoming resistant to the last antibiotics that work reliably against them.

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Exotic Travel? Take Your Precautions Seriously. (Or Die.)

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So, these deadlines: They’ve been intense. (I know, I said last week I thought I was done. I was wrong. But now I think I’m done — though chairing a conference for the rest of the week, so still busy.) While I’ve been underwater, there has been literal tons of news on this blog’s core topics, all of which I need to get back to. But while I’m getting re-oriented, here’s an intriguing piece of news that I stashed last month for consideration. It’s worth thinking about, if you’re planning exotic travel.

TL;DR: If you’re going somewhere where you run the risk of being exposed to a disease that your doctors back home might not recognize, and you can take simple steps to prevent it, you should. Really. Wear your bug repellent, stay out of the stagnant water, keep your skin covered, take your pills. [Read more…]

Does Foodborne Illness Trigger Lifelong Health Problems?

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I have a new column up at Scientific American about a health issue that is really just starting to be discussed: Whether foodborne illness causes long-term health problems, and therefore whether it should be a higher medical and public-health priority than it is now.

Quick summary: The few studies that have followed victims of foodborne illness for years afterward show that later in life, they suffer higher-than-usual rates not only of digestive trouble, but of arthritis and kidney problems, as well as greater risk of heart attack and stroke.

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High Levels of Resistant Bacteria on Meat (Again)

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A new report is out from the federal collaboration that monitors antibiotic resistance in animals, retail meat and people, and the news is not good.

The full title is the 2010 Retail Meat Report from the National Antimicrobial Resistance Monitoring System. This report is issued by the Food and Drug Administration; the humans one comes from the Centers for Disease Control and Prevention and the animals one from the US Department of Agriculture. It reports the results of testing on 5,280 meat samples collected in 2010 in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee, and Pennsylvania. (Those are sites of state labs participating in a federal surveillance network, FoodNet, plus one volunteer lab, Maryland.)

The report — which is broken down first by foodborne organism and then by meat type — notes a number of instances where either the percentage of bacteria that are antibiotic resistant, or the complexity of the resistance, is rising. Quoting from the report:

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Antibiotics: Connected to Obesity, Diabetes and Stroke?

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In consideration of your glaze-eyed tryptophan coma — at least among those who weren’t frightened off by the MRSA-in-turkey news — today’s post is mostly composed of brightly colored pictures. (Also, speculation. You’ve been warned.)

About a week ago, a nonprofit research group called Extending the Cure published the latest in a fantastic series of maps they have been producing for several years, based on public and privately collected data. Earlier iterations have looked at the incidence of various resistant organisms over time. This time, they decided to look instead at the major drivers of resistance, and focused on national data about antibiotic prescriptions, broken down by drug type and by state between 1999 and 2007.

The graphics they produced document both a troubling growth in the use of some precious (because still effective) antibiotic classes, and also a surprising differential in the amounts of antibiotics prescribed in different parts of the country. The rate of use of antibiotics, measured by outpatient prescriptions per 1,000 inhabitants, varied from a low of 533 in Alaska to a high of 1,214 in West Virginia. [Read more…]

Running Out of Antibiotics: Europe Gets It

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In the United States, it’s been “Get Smart About Antibiotics” Week this past week, an annual observance in which the Centers for Disease Control and Prevention and its medical and public health partners try to raise awareness of antibiotic resistance. The real action this week though was in Europe, where individual researchers and the EU’s version of a CDC — the European Centre for Disease Prevention and Control — are speaking out about the problem with unusual candor.

Here’s the short version: In Europe, according to the ECDC, 25,000 people each year die as a result of multi-drug resistant infections, causing an additional cost to society of 1.5 billion Euros ($2.02 billion): 938 million Euros ($1.27 billion) in hospital and outpatient medical costs, and an additional  596.3 million Euros ($806 million) in lost productivity.

Dr. Marc Sprenger, director of the ECDC, said Friday:

This certainly is an underestimate of the true economic impact of antimicrobial resistance. In particular, the figures were based on data for just five multidrug-resistant bacteria.The estimate was also based on a conservative figure for the cost of a day in hospital… We think the real cost of treating a patient with a multidrug-resistant infection would be higher than this. My take home message is that antimicrobial resistance is one of the most serious public health challenges that we face.

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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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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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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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