Maryn McKenna

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To Slow Down Drug Resistance in Health Care, Buy an Antibiotic-Free Turkey for Thanksgiving

November 19, 2014 By Maryn Leave a Comment

Organic turkey poults, Lance Cheung, USDA. CC on Flickr

Organic turkey poults, Lance Cheung, USDA. USDA/Flickr

I thought it might be time to switch away from Ebola and catch up with other disease problems that continue to occur in the world. (If you miss Ebolanoia, though, I’m still collecting instances at my Tumblr. The latest: Indian authorities have force-quarantined in an airport a man who returned from West Africa with a clean bill of health and negative blood tests. They say they will not allow him to leave until his semen tests negative for Ebolavirus. Yes, they are insisting on samples.)

So: How can healthcare workers contribute to slowing down antibiotic resistance? A healthcare nonprofit suggests they commit to buying an antibiotic-free turkey for Thanksgiving.

If it feels like the problem in one sphere, medicine, doesn’t have much to do with the other, agriculture, then you are the perfect target for this pledge. (Even if you don’t actually work in health care.)

Here’s the backdrop to the campaign, created by Health Care Without Harm,the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative, and the Pediatric Infectious Disease Society (PIDS):

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, ECDC, Resistance, Thanksgiving, Turkey

The Mathematics of Ebola Trigger Stark Warnings: Act Now or Regret It

September 14, 2014 By Maryn Leave a Comment

Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

The Ebola epidemic in Africa has continued to expand since I last wrote about it, and as of a week ago, has accounted for more than 4,200 cases and 2,200 deaths in five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone. That is extraordinary: Since the virus was discovered, no Ebola outbreak’s toll has risen above several hundred cases. This now truly is a type of epidemic that the world has never seen before. In light of that, several articles were published recently that are very worth reading.

The most arresting is a piece published last week in the journal Eurosurveillance, which is the peer-reviewed publication of the European Centre for Disease Prevention and Control (the EU’s Stockholm-based version of the US CDC). The piece is an attempt to assess mathematically how the epidemic is growing, by using case reports to determine the “reproductive number.” (Note for non-epidemiology geeks: The basic reproductive number — usually shorted to R0 or “R-nought” — expresses how many cases of disease are likely to be caused by any one infected person. An R0 of less than 1 means an outbreak will die out; an R0 of more than 1 means an outbreak can be expected to increase. If you saw the movie Contagion, this is what Kate Winslet stood up and wrote on a whiteboard early in the film.)

The Eurosurveillance paper, by two researchers from the University of Tokyo and Arizona State University, attempts to derive what the reproductive rate has been in Guinea, Liberia and Sierra Leone. (Note for actual epidemiology geeks: The calculation is for the effective reproductive number, pegged to a point in time, hence actually Rt.) They come up with an R of at least 1, and in some cases 2; that is, at certain points, sick persons have caused disease in two others.

You can see how that could quickly get out of hand, and in fact, that is what the researchers predict. Here is their stop-you-in-your-tracks assessment:

In a worst-case hypothetical scenario, should the outbreak continue with recent trends, the case burden could gain an additional 77,181 to 277,124 cases by the end of 2014.

That is a jaw-dropping number.
[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, Ebola, ECDC

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

Almost-Untreatable Gonorrhea: Proof That It's Here

January 11, 2013 By Maryn Leave a Comment

If you’ve been following this blog for a while, you might have noticed a thread on health authorities’ growing concern over gonorrhea not responding to the drugs used against it. (And if you didn’t notice you can find those posts here.) A paper published Wednesday evening shows that worry has not been misplaced.

The concern is this: Treatment of STDs in infected people, and programs that aim to keep STDs from spreading from those people to others, rely on drugs that are inexpensive to buy, simple to administer, and work after a single dose and clinic visit. Since the late 1990s, there have been only two drugs that fulfill those criteria: an oral drug called cefixime and an injectable called ceftriaxone (both belonging to the same broader drug family called third-generation cephalosporins). Since the early 2000s, there have simultaneously been signs that resistance to cefixime has been spreading from the Pacific Rim — Japan and Hawaii — to North America, Europe and the rest of the world.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, ECDC, gonorrhea, Resistance, Science Blogs, Who

The New Coronavirus: More Cases, More Deaths, Unclear Transmission

December 13, 2012 By Maryn Leave a Comment

Lung tissue containing the original SARS coronavirus (CDC, 2003)

There’s lots of news to catch up with regarding the new coronavirus that emerged last summer in the Middle East and has been causing concern to international health authorities all autumn: additional cases, additional deaths, and new lab evidence that is more than a little concerning.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: coronavirus, ECDC, hCoV-EMC, MERS, Qatar, SARS, Saudi Arabia, Science Blogs, Who

Drug-Resistant Gonorrhea: Not Just A U.S. Problem

August 3, 2012 By Maryn Leave a Comment


If you’ve been reading along, you might remember that in the past year, there has been increasing alarm in the public health community about rising rates of drug-resistant gonorrhea, an almost-beaten sexually transmitted disease that has steadily become resistant to just about all the drugs that can be used against it in the outpatient clinics on which STD control relies. (If you haven’t been reading along, then first, Welcome, and second, here are one two three four posts about the problem.)

Highly resistant gonorrhea — which is to say, gonorrhea that has already become resistant to sulfa drugs, penicillin, tetracycline, and fluoroquinolones such as Cipro, and that is gaining resistance to cephalosporins — first emerged in Japan and over the past decade was carried to the western United States, and then crossed the country. But a recent issue of EuroSurveillance, the journal of the European Centre for Disease Prevention and Control, warns that cases are now increasing in Europe, and exhibiting resistance against the last drug that both worked and was uncomplicated to use.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, cephalosporins, ECDC, gonorrhea, olympics, Resistance, Science Blogs

Running Out of Antibiotics: Europe Gets It

November 20, 2011 By Maryn Leave a Comment

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.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, antibiotics, CDC, ECDC, Europe, Klebsiella, Resistance, Science Blogs

E. coli: A Risk for 3 More Years From Who Knows Where

July 7, 2011 By Maryn Leave a Comment

The latest news from the European Centre for Disease Prevention and Control, the EU’s CDC, suggests that the massive outbreak of E. coli O104 is declining. The number of new cases being discovered has fallen, and the most recent onset of illness among confirmed cases was June 27. The  toll is now 752 cases of hemolytic uremic syndrome and an additional 3,016 cases of illness in 13 countries, for a total of 3,768 illnesses including 44 deaths. (The EU adjusted that total to remove 161 cases that were suspected but not lab-confirmed. It also did not include the five confirmed cases, one suspect case and one suspect death in the United States.)

But a simultaneous report from the European Food Safety Authority (EFSA) reveals that, despite the epidemic curve’s trending down, the outbreak can’t be considered over. The ultimate source — the contaminated seeds from which salad sprouts were grown — has been so widely distributed that no one really knows where they have gone or for how long they might remain for sale. One prediction, based on the probable package labeling, is that they could remain on shelves for three more years.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: E. coli, ECDC, food, food policy, foodborne, Science Blogs, Who

Disease + mosquitoes + climate change = Uh-oh

September 30, 2010 By Maryn Leave a Comment

A few days ago, health authorities in southern France announced that they’d found two cases of the mosquito-borne disease chikungunya in the Var, in Provence. Chikungunya is a nasty disease; it causes high fevers and severe joint pain, and its name comes from words in a Mozambiquan dialect that describe victims being “bent over” in spasms. Chikungunya perks along steadily in the tropics — Africa, Asia, India — and every year, a few travelers arrive back in the temperate zones suffering from infections they picked up on holiday (e.g., into Europe from the Maldives and from Thailand, both in 2009).

There was something unusual about the cases in the Var, though. Neither of the victims, 12-year-old girls who are friends and live in the town of Frejus, had been outside France. They were the first locally acquired cases of chikungunya that France has ever recorded. And they happened to follow, by two weeks, the discovery of France’s first locally acquired cases of dengue, which is, after malaria, the most serious mosquito-borne disease in the world.

So, on the one hand: Few cases, everyone treated, nobody died.

On the other hand: An early warning signal worth listening to.

Unlike some other vector-borne diseases, chikungunya and dengue are carried only by humans; there are no intermediate hosts, no birds or deer or horses to keep the organism circulating in the environment. A human gets bitten by a mosquito; the mosquito bites someone else; the infection passes on. That tight cycle of transmission requires only a few things: that the human be recently infected, so that the viral load in the blood is relatively high; that the mosquito be one of the few species that transmit the disease; and that the mosquito population be robust — and, ideally, not killed off by winter temperatures.

Put them all together, and you get the Democratic Republic of the Congo in 2004, Reunion Island in 2006 and Singapore in 2008 — all significant epidemics, all tropical locations. But you also get Ravenna, in northeast Italy, where there was an outbreak of more than 200 cases of chikungunya in summer 2007. Ravenna is hardly tropical. Neither is Frejus. But both of their outbreaks started with a recently arrived traveler: a visitor from India in Ravenna, and in Frejus apparently a 7-year-old girl who was in Asia with her family. And both areas share something that gravely worries global-health planners: an apparently increasing population of the key mosquito species, which have ranged further north as average temperatures rise.

In Europe, chikungunya (and dengue) are being spread by Aedes albopictus, the Asian tiger mosquito. It used to be only a tropical species, but it was first spotted in Europe in 1979, in Albania, and it arrived in Italy in 1990. It’s not a long-distance flyer, just a smart adapter: It’s moved around the world, including to the United States (more on that in a minute), via shipments of used tires and sales of those “lucky bamboo” stalks you can find in any gift shop. It has landed in places as far north as Germany and the Netherlands, and has established itself in Albania, Croatia, France, Greece, Monaco, Montenegro, Slovenia and Spain, with the densest populations in Italy.

Where will it go, facilitating disease spread as it moves? The European CDC took an in-depth look at the possibility a year ago. In a report plugging in a variety of climate change models, they concluded there isn’t really, any good news. On the left, in red, is their most conservative short-term estimate of the mosquito’s likely range (for 2010; the maps were generated in 2008 and the report published in 2009); on the right, the most pessimistic estimate, for 2030. Either way, that’s a lot of potential disease transmission.

So what about the United States? By 2006, 37 travelers had arrived in 17 states and Washington DC while infected with or recovering from chikungunya; five of them were viremic enough to be potentially infectious. And in 2008, 14 church workers came back to the US with active dengue— but by luck, returned to the cold-climate states of Minnesota and Iowa, where mosquitoes don’t live very long. They persist for much more of the year in Key West: Between September 2009 and April this year, 28 people, some of them snowbirds from northern states, were infected with dengue in the first local, sustained US outbreak since 1945.

When the European CDC was calculating the potential current range of the mosquitoes that carry dengue and chikungunya, one of the measures they used was mean annual temperature: At a mean of 11 C (52 F), Ae. albopictus are more likely to survive the winter and so hang on from year to year. When you map the United States by mean annual temperature, this is what it looks like; anywhere in yellow is warm enough, long enough, to keep the mosquitoes going.

So, to recap: First Italy, and then France, experienced infected travelers returning to areas where newly established mosquito populations were large and long-lived enough to sustain the importation of disease. In the US, we know we have the travelers; we can see we have the mosquitoes; and given the Key West dengue outbreak, we know transmission of disease by the same mosquito vector has already happened.

In an early sign of what might come next, the Iowa Electronic Health Markets— a prediction engine for disease outbreaks — has just opened a market on the likelihood of dengue occurring in the US.

It might be time to buy a little more DEET.

Maps from Technical report: Development of Aedes albopictus risk maps, ECDC, 2009. Image courtesy of Flickr user Matteo Dudek. Inspiration from ProMED Mail.


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

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