“There’s a woman who came up crying to me tonight after the debate. She said her daughter was given  [the HPV] vaccine. She told me her daughter suffered mental retardation as a result of that vaccine.”

Since that statement came out, the medical community [pdf] has responded with a resounding push back.   The side effects of HPV are rare, with New York Magazine Daily Intel reporting on the CDC’s declaration that:

“35 million doses of Gardasil were distributed as of June 22, 2011, resulting in 18,727 reports of adverse events. Ninety-two percent [approximately 17,250] of those adverse events were “non-serious” and included things like “fainting, pain, and swelling at the injection site (the arm), headache, nausea, and fever.”

And of the other 8 percent [approximately 1500 out of the 35 million doses given]?  New York Magazine interviewed Dr. Kevin Ault of Emory University:

“There’s been a nice study from the CDC that basically [showed that] if you compare a group of people who got the vaccine to a group of people who didn’t get the vaccine, all these things are rare and they occur equally [ in both groups].”

“Careless carriers, contact cases, chiefly cooks, dirty drinking water, the dust of dried dejecta, and the repulsive regurgitation, dangerous droppings, and filthy feet of fecal-feeding flies fouling food”

Now if only I hadn’t already submitted my dissertation title…

Previous studies have shown that player position is often associated with increased risk of MRSA infection during an outbreak, as is increased BMI, but only BMI appeared statistically significant during this particular case.

MRSA is responsible for a high mortality rate among infected, as mentioned by revere at Effect Measure in a recent post about a study in PNAS by Aetiology blogger where MRSA is found in a pig farm in the United States.    The strain in the pig case (ST398) is different then the strain in this particular pigskin case (US300).

MRSA is the current superbug, and concern about spreading through fomites (in hospitals and lockerrooms alike) is only going to increase.

Trachoma is an infectious eye disease caused by Chlamydia trachomitis.  [Side note: inour lab safety training, the safety coordinator tells a story about how she got Chlamydia in her eye when she was working in the lab]  A typical infection, which lasts for 5-12 days, causes conjunctivitis-like symptoms, with eye inflamation leading to irritation and discharge.  If you visited the poorest of regions in Africa, Asia, the Middle East, and/or Latin America, and ended up with Trachoma, it’d be no big thing.  Your doctor would hand you antibiotics like he always does and you’d keep on walking.  But the locals who are continually re-infected with Trachoma end up with permanent blindness.  The constant inflamation from repeat infections leads to entropian, a painful form of blindess, which (according to Wikipedia) is the leading cause of infectious blindness.

Gross.

So trachoma is spread through contact with eye, nose, and throat secretions.  Either by direct contact, indirect contact via fomites, or indirect contact via vectors (like flies and cattle).  People who like the F-diagram say it is spread through feces, flies, fomites, and fingers.

The fomites in question are thought to be items like towels, but the speaker mentioned that the cloths women use to wrap and hold their babies [is kitenge the right word?  When i Googled it, i just got a bunch of photos of the whitest people wrapping random African-looking cloths around themselves and their sun-deprived babies,  so there's probably a better word out there] rubs right against the baby’s eyes, allowing discharge from one infection to continually cause reinfection.

So secretions appear to be the main form of transmission, but the speaker’s premise for the talk was that sanitation would reduce incidence of Trachoma because it would remove feces from areas where individuals and flies had access.  In general, promoting sanitation is always a great thing, but I’m not completely sold on its usefulness in combating an infectious disease spread through secretions.

And, perhaps, neither are the individuals at WHO working on its elimination who apparently rely heavily on the use of antibiotics to treat individuals, instead of trying to interrupt the transmission pathway.

Triclosan is an antibacterial that binds to an enzyme in bacteria that is used to build fatty acids, a necessary component in bacterial cell membranes.    Notice, I said that it is an antibacterial and not an antibiotic.

Triclosan’s efficacy in hand soap is debatable.  Some studies have shown that hand washing is not improved with the addition of triclosan, if the recommended 30 second social hand wash is followed.  Others contend that triclosan provides a residual on the hands that continues to work against bacterial contamination, useful in settings where people do not wash their hands completely or correctly.  Most consumer products, like cutting boards, table tops, and children’s toys, that bear the term antibacterial likely have triclosan imbedded in the surface.

Additionally, soap with high concentrations of triclosan (think 2% compared to the 0.5% found in consumer soaps) are used to decontaminate individuals exposed to MRSA.

So why is it news that the EPA extended triclosan’s approval?

1) There is some (ok, very little) concern about antibacterial resistance developing, which seems unlikely unless organisms currently resistant (such as P. aeroginosa) are able to transfer resistance to other species.

2) Triclosan degrades in sunlight to form byproducts in a class of compounds known as Dioxins, which bioaccumulate in fatty tissue and pose a threat to the reproductive, sexual development, and immune systems and are probable carcinogens.  With household use sending triclosan directly down the drain to the waste water treatment plant, it frequently ends up in surface waters where it becomes an environmental pollutant.

and 3) The ES&T article mentions, through Cathy Propper at NAU, that triclosan bioaccumulates and impacts nitrogen fixation in microbial communities and plants.

My take?  Totally not necessary.  Just wash your hands well.  Wash your cutting board well.  Your table top…  Why contribute to a problem we have no idea of the magnitude of for the sole benefit of maybe, possibly, protecting ourselves environmental bacteria?

We’ll see what the EPA says when it comes up again in 5 years…

Seasonal Variation in Google Search Term "rotavirus".

This shows a surprisingly seasonal trend.  Fourier analysis on the trend in the search term (using data gleaned through digitization for the 2004-2006 seasons, the only information available the last time I did this) showed Cp peaks at 204 and 345 days.

Why?  I can think of two reasons.  One: media sensationalism warns of upcoming Rotavirus epidemics because it is a predictable seasonal disease, causing an increased interest in using it as a search term.  Two: Doctors diagnose people with rotavirus as a possible cause for their gastroenteritis, and people are more interested in learning about it.

If the second case is true, then you have a real time, easily accessible, proxy for number of rotavirus diagnoses in a given region (in the above case, the entire U.S.).  Instead of requiring the headache of a giant linked database for doctors/nurses/patients to enter the disease incidence, you only need people to type in the search term “rotavirus” into a Google browser, and you have “logged” an incidence of inquiry of the disease.

Google, thankfully, has now caught on the link between interest in searching for an illness and level of the disease with Google Flutrends.

This is incredibly awesome.  But, there is a lot more to be done.  One of the major advancements would be moving away from the artificial and meaningless boundaries of states, and trying to push for a more geographically relevant mapping.  For example, with today’s travel plans, it is a lot more relevant to Los Angeles if New York City is having a flu epidemic than if Arizona is.  A good use of someone’s time might be developing meaningful boundaries based on interactions between people in those locations.  I don’t know if this has been done, but something similar has been proposed.

Additionally, this demonstrates the use of Google’s existing information infrastructure for web-based technology to implement an easy and efficient method of geographically databasing existing diseases.  How easy would it be to ask a nurse to open a website (say something like diseasetracker.google.org) and literally just type in the diagnosis (e.g. breast cancer).   Or, better, ask patients to log in from their homes to get more-spatially relevant data.  The tracker immediately logs the address located to the IP and the diagnosis.  Instant Illness-related GIS.  Privacy shouldn’t be a concern.  Google could obscure the location of the IP Address to within 10 miles to protect patient identification.  Even with only 10 mile resolution we would have a significantly better system in place to track clusters of disease.

What will they come out with next?

The new formulation, Purell VF481, is showing a 4 log reduction of norovirus and adenovirus using the fingerpad test with infected stool to artificially inoculate fingers.  Concentrations of adeno-/noro- are determined using quantitative reverse-transcriptase, with the log reduction a comparison of concentrations on fingers before and after ABHS use.  Since this is working so well against non-enveloped virus, I wonder how it does against spore-formers.

I have no idea what the active ingredient is for VF481.   A Google Search of “Purell VF481″ only turns up about 170 listings.  The method of ethyl alcohol inactivation doesn’t mesh with increased virucidal activity.  I think there’s something else in there.

According to “Disinfection, Sterilization, and Preservation” by Seymour Block: for both bacteria and virus: methanol < ethanol < isopropanol < propan-1-ol.  Maybe that has something to do with it…

Anyway they’re already selling it (in Europe at least)… so I imagine the ingredient is listed right on the packaging.

I’d like to point out CDC recommendations:

To prevent Salmonella infections, persons should wash their hands for at least 20 seconds with warm water and soap immediately after handling dry pet foods, pet treats, and pet supplements, and especially before preparing and eating food for humans.

These recommendations are the same for handling likely contaminated foodstuffs like raw chicken, even though this is fomes-mediated transmission, not foodborne.  The CDC also mentions feces as a source; this strain of Salmonella schwarzen-grunde can pass right through the gut of a pet without the pet showing signs of illness.  Animals are definitely not vectors in this.

The CDC states that children should be kept away from “pet feeding areas” and not be allowed to “touch or eat pet food”.  This added emphasis on children is because they are disproportionally becoming ill:  the median age is 8 months and six of the eight diagnosed are <2 yo.  This disparity is probably due to an increased likelihood of reporting.  Poor immunity probably also plays a large role. I doubt its level of activity or interaction with the pet food because I’d obviously expect that a greater proportion of adults are feeding their animals.  Adults who become ill are unlikely to make the connection with the dog food, and also unlikely to report to a doctor/hospital because of it.  Plus, I’d expect that children in the 2-5 yo age range are the most likely to  unintentionally eat pet food, not the <2 yo age range.   It would be nice to have information on this, though.  The route of transmission is probably pet food/feces-to-parent-to-child.

So, wash your hands.