XDR-TB travels around the globe, update: broader implications of one man’s jaunt

I blogged earlier about the Georgia man who globe-trotted while infected with XDR-TB. I wrote that post late Tuesday evening, and since then, a number of other details about his case have come to light–and they’re not encouraging. In fact, this serves as a nice example of a convergence of a number of areas I’ve written about before–obviously, the evolution of antibiotic resistance and the terrible position it leaves us in, the politics and policies of quarantine/isolation (and how they’d be enforced), and the global spread of infectious disease, so I figured this would warrant another post on the topic.

First, the “compelling personal reason” he had for traveling that was mentioned in early articles was this: that he he was getting married in Greece and then honeymooning in various stops around Europe. Now, I’m probably just unsentimental and maybe a bit too practical at times, but it seems to be a really poor idea to potentially expose not only your future wife (who apparently was tested in January and negative for TB) but also your relatives and other loved ones to a highly deadly bacterium on what’s supposed to be one of the happiest days of your life. I mean, sure, you want people to remember your wedding, but not because they contracted tuberculosis there.

That’s only the beginning of the dumbassery, unfortunately–it gets worse. More after the jump.
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Microbes on a plane

I blogged back in March about World TB day, the theme of which was “TB anywhere is TB everywhere.” We know that someone can simply hop on a plane halfway across the world, and be practically anywhere else on the globe in the span of about a day–and their bacteria and viruses are just along for the ride. This is particularly disconcerting when it comes to respiratory diseases, where fellow airline passengers may be coughing and sneezing all over you, or touching shared objects without washing their hands. This is also a scenario that’s known to have spread SARS, and may spread a future pandemic influenza strain.

What’s equally worrisome is that this method of travel also has the ability to spread highly antibiotic-resistant bacteria, such as extremely drug-resistant Mycobacterium tuberculosis (XDR-TB) all around the globe. And it’s more than just a hypothetical. A new story reveals that a passenger did, indeed, board a plane here in Atlanta, flew to Paris, ended up in Prague, and then flew back to Montreal and drove back into the U.S.–and he was infected with XDR-TB.

More after the jump…
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The long shadow of smallpox

Smallpox is, without a doubt, the biggest success story in all of vaccination. The practice of variolation, or the purposeful inoculation of naïve individuals with material from scabs of smallpox victims, was practiced for years prior to Edward Jenner’s substitution of cowpox for the smallpox (Variola) virus. The vaccinia virus, thought to be a derivative of cowpox, has been used in the 20th century in smallpox vaccination campaigns. Vaccina elicits antibodies that protect from smallpox infection, yet typically causes an asymptomatic or only mildly symptomatic infection. This worldwide effort led to the last known naturally-occurring case of smallpox, which occurred in 1977 in Somalia. (The last known U.S. case dates back to 1949). However, in the aftermath of 9/11 and fears over the use of bioweapons, the U.S. military instituted the controversial smallpox vaccination program, as part of the Department of Defense’s “national strategy to safeguard Americans against smallpox attack.” To date, over a million service people have been vaccinated. This program has been in the news several times recently, as vaccinia infections have spread beyond the vaccinated individual and to family members and now, sexual partners. More after the jump.
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Yet another study shows no link between abortion and breast cancer

Last summer, I mentioned that groups receiving federal funding were providing misleading information about abortion, including the unsupported statement that having an abortion increases the risk of development of breast cancer. As I noted, this “link” has been refuted by a number of analyses, including a 2004 Lancet paper and a 2003 National Cancer Institute report. As if those weren’t enough, a new study comes to the same conclusion: yep, no link. More after the jump.
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Influenza and masks, redux

It’s difficult to believe that it’s been over a year since I last wrote a post on the use of masks in the event of an influenza pandemic. Since then, there’s been a virtual glut of information out there, and from what I’ve seen at least, people, businesses, organizations, government, etc. interested in preparation seem to be taking more of a structured approach, rather than a knee-jerk reaction that we saw last year with Tamiflu hoarding and stockpiling masks, which, as I mentioned in the post linked above, have uncertain effectiveness in the event of a pandemic.

I also noted that one big problem is that the masks (typically recommended is the N95 mask) often don’t fit properly, greatly reducing their effectiveness. Additionally, people simply don’t know how to use them correctly and consistently. A new paper in Emerging Infectious Diseases confirms these statements, after observing individuals use N95 masks in post-Katrina New Orleans.
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World TB day 2007: “TB anywhere is TB everywhere”

Mycobacterium tuberculosis infection is as old as civilization. The bacterium infects approximately a third of the world’s population–roughly 2 billion individuals. It’s estimated that 8 million new cases are contracted each year–around a new infection every second. ~2 million individuals die as a result of TB every year. The bacterium also plays a prominent role in the history of microbiology: it was on March 24, 1882, that Robert Koch announced his discovery of the causative agent of the dread disease tuberculosis:

“If the importance of a disease for mankind is measured by the number of fatalities it causes, then tuberculosis must be considered much more important than those most feared infectious diseases, plague, cholera and the like. One in seven of all human beings dies from tuberculosis. If one only considers the productive middle-age groups, tuberculosis carries away one-third, and often more.”

Unlike many other feared infectious diseases of Koch’s time, TB still remains a significant killer worldwide, and its effect has only been exacerbated by the AIDS epidemic. However, a concentrated effort is being made to again attract attention to this bacterium.
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Streptococcus costs young mother her arms and legs

I’ve mentioned a few times the work of Ignaz Semmelweis in preventing “childbed fever” in new mothers. To recap:

Semmelweis was a physician in Vienna in the 1840s, with an interested in “childbed fever,” a leading cause of mortality in women who’d given birth. During this time, he noticed that the mortality rate from this disease in a hospital division where medical students delivered babies was 16%, while in a division where midwives delivered them was ~2%. It was also known that childbed fever was rare when women gave birth at home. Semmelweis thought there was something the med students were doing that served to raise the rates of childbed fever in those divisions.

In 1847, Semmelweis’ friend, another physician, died due to a wound acquired while performing an autopsy. Semmelweis examined the tissues of his friend, and noticed the pathology there was similar to those in women who’d died of childbed fever. According to history, this led to his “eureka” moment: medical students performed autopsies, and midwives did not. The students must be bringing some contagious agent from the autopsy room back to the delivery room.

This contagious agent was later found to be the group A streptococcus, Streptococcus pyogenes. Since the early 1990s, this bacterium has regained notoriety due to its ability to cause what the media has dubbed “flesh-eating disease” (or to those who speak medical-ese, necrotizing fasciitis). In a strange and tragic story, it seems that streptococcus has struck again in a young mother, sparing her life but costing her arms and legs:
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What would *you* buy with a trillion dollars?

Via Jonah comes this (depressing, as he notes) NY Times article on what else we could’ve bought with $1.2 trillion:

For starters, $1.2 trillion would pay for an unprecedented public health campaign — a doubling of cancer research funding, treatment for every American whose diabetes or heart disease is now going unmanaged and a global immunization campaign to save millions of children’s lives.

Combined, the cost of running those programs for a decade wouldn’t use up even half our money pot. So we could then turn to poverty and education, starting with universal preschool for every 3- and 4-year-old child across the country. The city of New Orleans could also receive a huge increase in reconstruction funds.

More after the jump…
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A chicken and egg question regarding wealth, education, and longevity

i-60ff33c45fe9eefb6e1ae6f3ffd66080-chicken or egg sm.jpg Gina Kolata has an interesting article from Wednesday’s New York Times, discussing education and longevity.

James Smith, a health economist at the RAND Corporation, has heard a variety of hypotheses about what it takes to live a long life — money, lack of stress, a loving family, lots of friends. But he has been a skeptic.

Yes, he says, it is clear that on average some groups in every society live longer than others. The rich live longer than the poor, whites live longer than blacks in the United States. Longevity, in general, is not evenly distributed in the population. But what, he asks, is cause and what is effect? And how can they be disentangled?


The answers, he and others say, have been a surprise. The one social factor that researchers agree is consistently linked to longer lives in every country where it has been studied is education. It is more important than race; it obliterates any effects of income.

Aging and longevity are areas where we have a few tantalizing pieces of information converging from so many different avenues, and yet we really remain clueless about what’s going on. It’s widely accepted that early exposures in childhood play a role in our later health–Kolata asks, how much of a role does our education play in this as well? More after the jump…
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Tripoli Six update: found guilty

Libya to execute HIV medics

(Previous posts on the topic)

A court convicted five Bulgarian nurses and a Palestinian doctor Tuesday of deliberately infecting 400 children with HIV and sentenced them to death, despite scientific evidence the youngsters had the virus before the medical workers came to Libya.

The United States and Europe reacted with outrage to the verdict, which prolongs a case that has hurt Libya’s ties to the West. The six co-defendants have already served seven years in jail.

The sentence brought cheers in Libya, where there is widespread public anger over the infections. The Libyan press has long depicted the medical workers as guilty.

After the sentence was pronounced, dozens of relatives outside the Tripoli court chanted “Execution! Execution!” Ibrahim Mohammed al-Aurabi, the father of an infected child, shouted, “God is great! Long live the Libyan judiciary!”

But the ruling stunned the defendants. They were convicted and sentenced to death a year ago, but the Libyan Supreme Court ordered a retrial after an international outcry that the first trial was unfair. The case now returns to the Supreme Court for an automatic appeal.

“This sentence was another blow, another shock for us,” Zdravko Georgiev, the husband of one of the nurses, Kristiana Valcheva, told the Associated Press in Bulgaria.

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