H5N1

Why is Lyme disease so hard to understand?

In The Atlantic, an important article by Meghan O'Rourke, a Lyme patient: Why Is Lyme Disease So Hard to Understand? Excerpt:

Even as changes in the climate and in land use are causing a dramatic rise in Lyme and other tick-borne diseases, the American medical establishment remains entrenched in a struggle over who can be said to have Lyme disease and whether it can become chronic—and if so, why. The standoff has impeded research that could help break the logjam and clarify how a wily bacterium, and the co-infections that can come with it, can affect human bodies. 

After 40 years in the public-health spotlight, Lyme disease still can’t be prevented by a vaccine; eludes reliable testing; and continues to pit patients against doctors, and researchers against one another. When I got my inconclusive diagnosis, I knew better than to dream of a quick cure. But I didn’t know how extreme the roller coaster of uncertainty would be. 

Lyme disease came into public view when an epidemic of what appeared to be rheumatoid arthritis began afflicting children in Lyme, Connecticut. A young rheumatologist at Yale named Allen Steere, who now conducts research at Massachusetts General Hospital, in Boston, studied the children. In 1976 he named the mysterious illness after its locale and described its main symptoms more fully: a bull’s-eye rash; fevers and aches; Bell’s palsy, or partial paralysis of the face, and other neurological issues; and rheumatological manifestations such as swelling of the knees. After much study, Steere realized that the black-legged ticks that live on mice and deer (among other mammals) might be harboring a pathogen responsible for the outbreak. 

In 1981, the medical entomologist Willy Burgdorfer finally identified the bacterium that causes Lyme, and it was named after him: Borrelia burgdorferi. 

B. burgdorferi is a corkscrew-shaped bacterium known as a spirochete that can burrow deep into its host’s tissue, causing damage as it goes and, in laboratory conditions at least, morphing as needed from corkscrew to cystlike blob to, potentially, slimy “biofilm” forms. Because of this ability, researchers describe it as an “immune evader.” Once it hits the human bloodstream, it changes its outer surface to elude an immune response, and then quickly moves from the blood into tissue, which poses problems for early detection. (Hard to find in the bloodstream and other body fluids, the B. burgdorferi spirochete is hard to culture, which is how bacterial infections are definitively diagnosed.) 

If it goes untreated, B. burgdorferi can make its way into fluid in the joints, into the spinal cord, and even into the brain and the heart, where it can cause the sometimes deadly Lyme carditis.

Air pollution and infant mortality: Evidence from Saharan dust

Via the National Bureau of Economic Research: Air Pollution and Infant Mortality: Evidence from Saharan Dust. The abstract:

Accurate estimation of air quality impacts on health outcomes is critical for guiding policy choices to mitigate such damages. Estimation poses an empirical challenge, however, because local economic activity can simultaneously generate changes in both air quality and in health impacts that are independent of air quality, confounding pollution-health estimates. 

To address this challenge, we leverage plausibly exogenous variation in local particulate matter exposure across sub-Saharan Africa due to dust export from the Bodele Depression, a remote Saharan region responsible for a substantial share of global atmospheric dust. Large scale transport of this dust is uncorrelated with local emissions sources and allows us to isolate the causal impact of air quality on infant mortality across Sub-Saharan Africa. 

Combining detailed information on nearly 1 million births with satellite measures of aerosol particulate matter, we find that a 10mg/m3 increase in local ambient PM2.5 concentration driven by distant dust emission causes a 22% increase in infant mortality across our African sample (95% CI: 10-35%), an effect comparable to quasi-experimental pollution-infant mortality estimates from wealthier countries. 

We also show that rainfall over the Bodele is a significant control on PM2.5 export and thus child health, and that future climate-change driven changes in Saharan rainfall could generate very large impacts on African child health through this pathway alone. 

We calculate that seemingly exotic proposals to pump and apply groundwater to the Bodele to reduce dust emission could be cost competitive with leading interventions aimed at improving child health.

Floodwater in New Orleans like 'toxic' stew, experts warn. Swimming in it? That's 'crazy'

Via nola.com: Floodwater in New Orleans like 'toxic' stew, experts warn. Swimming in it? That's 'crazy'. Excerpt:

On a day like Wednesday, when the New Orleans area was pounded with as much as seven inches of rain in less than three hours, it may seem like the only way past floodwater is through it. However, experts warn that wading — and especially swimming — through a flood could expose people to a stew of toxic waste and chemicals. 

One video making the rounds on social media showed someone swimming through several feet of water near Canal Street. 

 "That is crazy," said Tiong Aw, a public health microbiologist at Tulane University. "It can be dangerous and can make humans susceptible to infectious diseases and injuries."  

Other experts agreed, noting all manner of potential hazards. 

“If you’re neighboring a rural area, human and livestock waste can get into the floodwater, which can be toxic to humans,” said D.J. Sprenger, a member of Team Rubicon, a disaster response team that provides rescue and resources to areas all over the country. 

“If a residential area is flooded, medical supplies or cleaning agents can be in the water. Wild or stray animals like water snakes or rodents could be swimming in the water,” Sprenger said. “Floodwater can contain downed power lines, and the water current could be charged after a storm.”

After Hurricane Katrina hit in August 2005, the Louisiana Department of Health and New Orleans Public Response Team identified 869 cases of potential infectious disease in the weeks immediately afterward and 18 cases of Vibrio skin infections. Vibrio bacteria live in coastal waters and are more active from May through October. Five of those 18 patients died.  

One 60-year-old man arrived at a hospital with ankle wounds and diarrhea after wading through floodwater in New Orleans for three days. Vibrio vulnificus was found in his blood, and he died the next day. 

That particular type of bacteria is known to cause necrotizing fasciitis, a gruesome condition commonly known as flesh-eating bacteria. 

Fortunately, Wednesday's flood seemed to be freshwater, said experts, and Vibrio only grows in brackish water.

World's rivers 'awash with dangerous levels of antibiotics'

Via The Guardian: World's rivers 'awash with dangerous levels of antibiotics'. Excerpt:

Hundreds of rivers around the world from the Thames to the Tigris are awash with dangerously high levels of antibiotics, the largest global study on the subject has found.  

Antibiotic pollution is one of the key routes by which bacteria are able develop resistance to the life-saving medicines, rendering them ineffective for human use. “A lot of the resistance genes we see in human pathogens originated from environmental bacteria,” said Prof William Gaze, a microbial ecologist at the University of Exeter who studies antimicrobial resistance but was not involved in the study. 

The rise in antibiotic-resistant bacteria is a global health emergency that could kill 10 million people by 2050, the UN said last month.

The drugs find their way into rivers and soil via human and animal waste and leaks from wastewater treatment plants and drug manufacturing facilities. “It’s quite scary and depressing. We could have large parts of the environment that have got antibiotics at levels high enough to affect resistance,” said Alistair Boxall, an environmental scientist at the University of York, who co-led the study. 

The research, presented on Monday at a conference in Helsinki, shows that some of the world’s best-known rivers, including the Thames, are contaminated with antibiotics classified as critically important for the treatment of serious infections. In many cases they were detected at unsafe levels, meaning resistance is much more likely to develop and spread. 

Samples taken from the Danube in Austria contained seven antibiotics including clarithromycin, used to treat respiratory tract infections such as pneumonia and bronchitis, at nearly four times the level considered safe. 

The Danube, Europe’s second-largest river, was the continent’s most polluted. Eight per cent of the sites tested in Europe were above safe limits.  

The Thames, generally regarded as one of Europe’s cleanest rivers, was contaminated, along with some of its tributaries, by a mixture of five antibiotics. One site on the river and three on its tributaries were polluted above safe levels. Ciprofloxacin, which treats infections of the skin and urinary tract, peaked at more than three times safe levels. 

Even rivers contaminated with low levels of antibiotics are a threat, Gaze said. “Even the low concentrations seen in Europe can drive the evolution of resistance and increase the likelihood that resistance genes transfer to human pathogens,” he says.

Revealed: Air pollution may be damaging 'every organ in the body'

Via The Guardian: Revealed: air pollution may be damaging 'every organ in the body'. Excerpt:

Air pollution may be damaging every organ and virtually every cell in the human body, according to a comprehensive new global review. 

The research shows head-to-toe harm, from heart and lung disease to diabetes and dementia, and from liver problems and bladder cancer to brittle bones and damaged skin. Fertility, foetuses and children are also affected by toxic air, the review found.  

The systemic damage is the result of pollutants causing inflammation that then floods through the body and ultrafine particles being carried around the body by the bloodstream. 

Air pollution is a “public health emergency”, according to the World Health Organization, with more than 90% of the global population enduring toxic outdoor air. New analysis indicates 8.8m early deaths each year – double earlier estimates – making air pollution a bigger killer than tobacco smoking. 

But the impact of different pollutants on many ailments remains to be established, suggesting well-known heart and lung damage is only “the tip of the iceberg”.  

“Air pollution can harm acutely, as well as chronically, potentially affecting every organ in the body,” conclude the scientists from the Forum of International Respiratory Societies in the two review papers, published in the journal Chest. “Ultrafine particles pass through the [lungs], are readily picked up by cells, and carried via the bloodstream to expose virtually all cells in the body.” 

Prof Dean Schraufnagel, at the University of Illinois at Chicago and who led the reviews, said: “I wouldn’t be surprised if almost every organ was affected. If something is missing [from the review] it is probably because there was no research yet.” 

The review represents “very strong science”, said Dr Maria Neira, WHO director of public and environmental health: “It adds to the very heavy evidence we have already. There are more than 70,000 scientific papers to demonstrate that air pollution is affecting our health.”  

She said she expected even more impacts of air pollution to be shown by future research: “Issues like Parkinson’s or autism, for which there is some evidence but maybe not the very strong linkages, that evidence is coming now.”

Adenovirus at the University of Maryland: Officials waited 18 days to inform students of the threat

Via The Washington Post: Adenovirus at the University of Maryland: Officials waited 18 days to inform students of the threat. Excerpt from an alarming report:

In November and December, the University of Maryland would become the epicenter of an outbreak of adenovirus, which can have symptoms similar to a cold or flu. But certain virulent strains can sicken healthy individuals and be particularly dangerous to people with weakened immune systems — people like Olivia, who was on medication for Crohn’s disease, a serious digestive tract condition.  

In these cases, medical experts say, early detection can be key to treating severe adenovirus. 

But the university waited 18 days to tell the community after learning the virus was present on campus. Officials discussed — but decided against — notifying students with compromised immune systems and residents living in Elkton Hall, according to records reviewed by The Washington Post. 

As the days passed, more and more students fell ill. 

Many parents and students have denounced the administration’s handling of the viral outbreak and the mold infestation, complaining its actions endangered thousands of students, faculty and staff on campus. In the end, more than 40 students were sickened with adenovirus, and 15 of them treated at hospitals, according to the university.

Stop denying the risks of air pollution

An editorial in Nature News & Comment: Stop denying the risks of air pollution.

Air pollution kills. Fine particles produced by cars, industrial plants and numerous other sources are particularly dangerous to human health. That is what scientists across the world have convincingly established over the past quarter of a century, and air regulations have been gradually tightened in most Western countries as a result. 

Even so, the World Health Organization (WHO) estimates that exposure to outdoor air pollution accounts for 4.2 million deaths each year. And in recent years, something insidious has happened in some places: the science linking air pollution to premature deaths has come under attack.  

The problem is most acute in the United States, where the administration of President Donald Trump is bent on dismantling a variety of environmental and public-health regulations. At a meeting last month, a science panel that advises the US Environmental Protection Agency on air-quality standards was divided on the extent to which fine-particle pollution causes premature death. The panel was chaired by Tony Cox, a Trump appointee, statistician and consultant whose research has been funded by oil, gas and other industries, and who has long questioned evidence supporting the link.  

Scepticism about air pollution’s health impacts has arisen in other countries, too, including France, Poland and India. And in Germany, 140 lung specialists signed a statement released in January that cast doubt on the health impacts of nitrogen oxides (NOx) and fine-particle emissions from vehicles. The statement acknowledged epidemiological evidence that people in areas with high levels of NOx and fine particulates tend to die slightly earlier than those elsewhere, but questioned whether pollution was the cause. 

Earlier this month, the German national academy of sciences set the record straight. NOx, and particularly nitrogen dioxide, increase rates of respiratory illnesses such as asthma while also contributing to the formation of fine particulates. The particulates contribute to premature death by increasing the risk of respiratory and cardiovascular diseases, as well as of lung cancer.  

These conclusions build on a body of evidence collected over decades. In 1993, researchers at the Harvard School of Public Health in Boston, Massachusetts, led a landmark study assessing the impacts of pollution in six US cities (D. W. Dockery et al. N. Engl. J. Med. 329, 1753–1759; 1993). 

After controlling for smoking and other potential confounding factors, they found that people tended to die earlier in cities with dirty air than in those with clean air — largely because of the presence of fine particles. Many subsequent studies have pointed in the same direction. In a 2017 study of nearly 61 million people, researchers reported that fine-particulate and ozone pollution — even at levels lower than the current US standard — were associated with increased death rates (Q. Di et al. N. Engl. J. Med. 376, 2513–2522; 2017). 

Cox and other sceptics often argue that the epidemiological evidence cannot prove that air pollution causes premature deaths. But that is deliberately ignoring the weight of evidence from an array of rigorous epidemiological studies, aligned with other sources of evidence. Scientists have identified mechanisms by which fine particles affect health, analysing the toxicological and physiological effects using in vitro methods, mice and human studies. As the evidence builds, many countries are rightly improving their pollution control. 

Environmental regulations to curb air pollution impose steep costs on a variety of industries, but questioning the evidence won’t make it go away. More than 90% of the world’s population lives in regions that break WHO air-quality guideline limits. Choking pollution still smothers major cities in places such as India and China. Now is not the time to undermine efforts to clean air — it is time to strengthen them.

Europe at risk from spread of tropical insect-borne diseases

Via The Guardian: Europe at risk from spread of tropical insect-borne diseases. Excerpt:

Insect-borne diseases such as dengue fever, leishmaniasis and encephalitis are on the rise and are now threatening to spread into many areas of Europe, scientists have warned.  

Outbreaks of these illnesses are increasing because of climate change and the expansion of international travel and trade, the European Congress of Clinical Microbiology and Infectious Diseases was told in Amsterdam on Saturday. 

Even previously unaffected areas in higher latitudes and altitudes, including some parts of northern Europe, are at risk of outbreaks unless action is taken to improve surveillance and data sharing, the researchers said. An adult female mosquito seen under a microscope. 

“Climate change is not the only, or even the main, factor driving the increase in vector-borne diseases across Europe, but it is one of many factors alongside globalisation, socioeconomic development, urbanisation and widespread changes to land use which need to be addressed to limit the importation and spread,” said the lead author Professor Jan Semenza, of the European Centre for Disease Prevention and Control in Stockholm. 

This point was backed by Giovanni Rezza, of the Istituto Superiore di Sanità in Rome. “Lessons from recent outbreaks of the West Nile virus in North America and the chikungunya virus in the Caribbean and Italy highlight the importance of assessing future vector-borne disease risks,” he said.  

Global warming has allowed mosquitoes, ticks and other disease-carrying insects to proliferate, adapt to different seasons and invade new territories across Europe over the past decade, with accompanying outbreaks of dengue in France and Croatia, malaria in Greece, West Nile fever in south-east Europe and chikungunya in Italy and France. 

Worryingly, the authors said, this might only be the tip of the iceberg. “Mediterranean Europe is now a part-time tropical region, where competent vectors like the tiger mosquito are already established,” added Rezza. And in future, hotter and wetter weather could provide ideal conditions for the Asian tiger mosquito, which spreads the viruses that cause dengue and chikungunya, to breed and expand across large parts of Europe, including the south and east of the UK and central Europe.

Association of air pollution exposure with psychotic experiences during adolescence

Via JAMA Psychiatry: Association of Air Pollution Exposure With Psychotic Experiences During Adolescence. The key points and abstract:

Key Points 

Question  Is exposure to air pollution associated with adolescent psychotic experiences?  

Findings  In this nationally representative cohort study of 2232 UK-born children, significant associations were found between outdoor exposure to nitrogen dioxide, nitrogen oxides, and particulate matter and reports of psychotic experiences during adolescence. Moreover, nitrogen dioxide and nitrogen oxides together explained 60% of the association between urban residency and adolescent psychotic experiences. 

Meaning  The association between urban residency and adolescent psychotic experiences is partly explained by the higher levels of outdoor air pollution in urban settings. 

Abstract 

Importance  Urbanicity is a well-established risk factor for clinical (eg, schizophrenia) and subclinical (eg, hearing voices and paranoia) expressions of psychosis. To our knowledge, no studies have examined the association of air pollution with adolescent psychotic experiences, despite air pollution being a major environmental problem in cities. 

Objectives To examine the association between exposure to air pollution and adolescent psychotic experiences and test whether exposure mediates the association between urban residency and adolescent psychotic experiences.

Design, Setting, and Participants  The Environmental-Risk Longitudinal Twin Study is a population-based cohort study of 2232 children born during the period from January 1, 1994, through December 4, 1995, in England and Wales and followed up from birth through 18 years of age. The cohort represents the geographic and socioeconomic composition of UK households. Of the original cohort, 2066 (92.6%) participated in assessments at 18 years of age, of whom 2063 (99.9%) provided data on psychotic experiences. Generation of the pollution data was completed on October 4, 2017, and data were analyzed from May 4 to November 21, 2018. 

Exposures  High-resolution annualized estimates of exposure to 4 air pollutants—nitrogen dioxide (NO2), nitrogen oxides (NOx), and particulate matter with aerodynamic diameters of less than 2.5 (PM2.5) and less than 10 μm (PM10)—were modeled for 2012 and linked to the home addresses of the sample plus 2 commonly visited locations when the participants were 18 years old. 

Main Outcomes and Measures  At 18 years of age, participants were privately interviewed regarding adolescent psychotic experiences. Urbanicity was estimated using 2011 census data. 

Results  Among the 2063 participants who provided data on psychotic experiences, sex was evenly distributed (52.5% female). Six hundred twenty-three participants (30.2%) had at least 1 psychotic experience from 12 to 18 years of age. Psychotic experiences were significantly more common among adolescents with the highest (top quartile) level of annual exposure to NO2 (odds ratio [OR], 1.71; 95% CI, 1.28-2.28), NOx (OR, 1.72; 95% CI, 1.30-2.29), and PM2.5 (OR, 1.45; 95% CI, 1.11-1.90). Together NO2 and NOx statistically explained 60% of the association between urbanicity and adolescent psychotic experiences. No evidence of confounding by family socioeconomic status, family psychiatric history, maternal psychosis, childhood psychotic symptoms, adolescent smoking and substance dependence, or neighborhood socioeconomic status, crime, and social conditions occurred. 

Conclusions and Relevance  In this study, air pollution exposure—particularly NO2 and NOx—was associated with increased odds of adolescent psychotic experiences, which partly explained the association between urban residency and adolescent psychotic experiences. Biological (eg, neuroinflammation) and psychosocial (eg, stress) mechanisms are plausible.

Butembo: Free healthcare has become partial

Via Radio Moto Butembo-Beni: BUTEMBO: Free healthcare has become partial. The Google translation is a bit confusing, but it's clear that healthcare—made free of charge in the hot zone for the duration of the Ebola outbreak—isn't entirely free any more.

This bias follows the failure to take care of certain diseases since the renewal of free on January 16, 2019. The announcement was made this Thursday, January 24, 2019 by the administrator managing the health institution, AGIS assigned to the KATWA Reference General Hospital. 

Confiding in the RMBB, this AGIS cited some diseases that are no longer treated free of charge in health facilities from January 16, 2019 to April 15, 2019. He cited in particular gynecology, surgery, any disease of internal medicine having a chronic character, known hypertension, diabetes and ambulatory care not referred. 

"According to the contract, it is until April 15, 2019. In this free, bias indexed the entire surgery: major or minor. There it is the patient who has to pay the bill of his care. The second is gynecological pathologies," he said. 

Nothing is yet known about the reasons for reducing the package of diseases supported by free care.