Abortive Rabies

Via ProMED-mail: the CDC reports on a rabies case from last year in which the victim was intermittently symptomatic ("severe frontal headache, photophobia, emesis, neck pain, dizziness, and paresthesia of face and forearms") for two and a half weeks before rabies vaccine and immune globulin were administered. She soon appeared to recover without intensive care.

This is the first reported case in which certain clinical and serologic findings indicate abortive human rabies and in which, despite an extensive medical investigation, no alternate etiology for the illness was determined. The patient's positive serologic results offer evidence of rabies virus infection; IFA and Western blot assays indicated the presence of antibodies capable of binding to rabies virus antigens before the patient received rabies PEP. Rabies virus can crossreact serologically with other members of the Lyssavirus genus, distributed in Australia, Eurasia, and Africa (5) or, theoretically, with as yet uncharacterized rhabdoviruses. However, this patient had no history of foreign travel and no evidence of infection with KCV, the only other rhabdovirus associated with bats in North America.
[...]
Certain other clinical and laboratory findings also support a diagnosis of abortive rabies in the patient described in this report. First, the onset of acute encephalopathy approximately 2 months after exposure to bats is compatible with documented incubation periods after rabies virus exposure. Second, central nervous system (CNS) findings (e.g., fever, photophobia, emesis, neck pain, dizziness, paresthesia, limitation of visual field, and altered behavior with agitation and combativeness) are compatible with clinical aspects of rabies. Although this patient did not have classic symptoms such as laryngeal spasms (manifested as hydrophobia) or autonomic instability, the lack of such symptoms has been documented in other rabies patients (1,2,6). Finally, despite an extensive medical workup, no alternate infectious etiology was identified for the patient's neurologic symptoms, increased intracranial pressure, and CSF pleocytosis.

I should note that, after her apparent recovery, the patient returned to the hospital two more times complaining of headaches, and afterwards went missing. ("The current clinical status of the patient or [sic] her boyfriend is unknown.") Judging from the reporting state, the patient was probably in the country illegally. PlagueBlog would not jump to the conclusion that she is still here, or still alive.

Mumps in NYC Update

Via ProMED-mail: the CDC reports that the mumps outbreak in New York/New Jersey has reached 1,521 reported cases, with no apparent end in sight. They also speculate about possible demographic causes of the outbreak in a relatively well-vaccinated community:

Like the mumps outbreaks that occurred in 2006 (2), much of the current outbreak is occurring in congregate settings, where prolonged, close contact among persons might be facilitating transmission. Within the affected religious community, cases have occurred predominantly among school-aged boys, who attend separate schools from girls. The higher rate among boys might be a result of the additional hours that boys in this community spend in school compared with girls, including long periods in large study halls, often face-to-face with a study partner.
In addition, transmission in the community overall might be facilitated by relatively large household sizes. According to the 2000 U.S. Census, the mean household size in one of the affected communities was 5.7, compared with a mean U.S. household size of 2.6. The limited transmission to persons outside the community might be a result of the relatively less interpersonal contact between persons inside and outside the community.
Although the school settings and large household sizes might be promoting transmission, the high vaccination coverage in the affected community likely is limiting the size of the outbreak. In addition, high vaccination coverage in surrounding communities is the most plausible reason that the few cases outside of the affected community have not caused other outbreaks.

PlagueBlog recommends letting the boys out for recess more frequently and sending them home earlier, poor things.

Mumps in NYC

Via ProMED-mail: the mumps outbreak in New York City continues, with over 900 cases identified so far. See the link for MMR clinics serving the apparently under-vaccinated population. The NYC Department of Health notes that:

Each site will have separate entrances for women and men and will have separate staff members to vaccinate them. The staff will be culturally sensitive and respectful.

At the risk of sounding culturally insensitive, PlagueBlog must state that there are worse things than getting an MMR shot from a member of the opposite sex who's just doing their job--for example, orchitis.

Mmm-mmm Melamine, Part MI

Via ProMED-mail: melamine has once again been detected in milk products in China. AsiaNews reports that the scandal has widened to six dairy companies, one of which was still in operation as of Friday.

China has also banned independent reporting of the scandal and jailed a food-safety activist:

Zhao Lianhai is a 37 year old former government employee from Beijing, who was recently arrested and charged with provoking social disorder.
His son was one of 300,000 kids poisoned by contaminated milk across China.
Mr Zhao used to work for the country's food quality and safety authority, so he started a website advising parents of affected children and campaigned to take responsible companies to court.

In other melamine news, on Friday a federal court sentenced the Chinese-American couple for importing the melamine-tainted wheat gluten from the 2007 pet-food scandal.

Mmm-mmm Cadmium, Part I

Via ProMED-mail: the Associated Press found cadmium in children's jewelry imported to the US from China. The LA Times reports:

For China's low-cost jewelry makers, it was an open trade secret: The metal cadmium is shiny, strong and malleable at low temperatures, regardless of its health hazards. And it's cheap.
Despite the risks, manufacturers in factories ringing this city on China's east coast say their top priority is profit. So offering cut-rate goods often means using lower quality materials, including cadmium, which is known to cause cancer.
"Business is business, and it's all up to our client," said He Huihua, manager of the Suiyuan Jewelry Shop at International Trade City in Yiwu[...]
Asked what he thought about the health risks associated with cadmium and other toxic metals, He said: "I can't be overly concerned about that."

PlagueBlog recommends a trade embargo.

Mmm-mmm Melamine, Part M

Via ProMED-mail: another melamine scandal has broken in China, once again belatedly, and once again involving tainted milk. The Wall Street Journal reports that the two-month investigation of Shanghai Panda Dairy Company began almost a year ago.

Shanghai Panda, one of the nation's smaller dairies, was among 22 companies originally implicated in the 2008 scandal and was briefly shut by quality inspectors.
Now, among the allegations against the company are that instead of destroying its melamine-tainted product that had been recalled in 2008, Shanghai Panda reconstituted the milk into new products.

Lovely.

Prion Evolution

Ed Yong discusses prion evolution in his blog at ScienceBlogs:

Jiali Li from the Scripps Institute in Florida has found that prions - the infectious proteins behind mad cow disease, CJD and kuru - are capable of Darwinian evolution, all without a single strand of DNA or its sister molecule RNA.
Prions are rogue version of a protein called PrP. Like all proteins, they are made up of chains of amino acids that fold into a complex three-dimensional structure. Prions are versions of PrP that have folded incorrectly and this misfolded form, called PrPSc, is social, evangelical and murderous. It converts normal prion proteins into a likeness of its abnormal self, and it rapidly gathers together in large clumps that damage and kill surrounding tissues.
Li has found that variation can creep into populations of initially identical prions. Their amino acid sequence stays the same but their already abnormal structures become increasingly twisted. These "mutant" forms have varying degrees of success in different environments. Some do well in brain tissue; others thrive in other types of cell. In each case, natural selection culls the least successful ones. The survivors pass on their structure to the "next generation", by altering the folds of normal prion proteins.

Marburg Reaches the US

Via ProMED-mail: the CDC reports on an imported case of Marburg hemorrhagic fever in Colorado last year. A bat-cave tourist came home from Uganda in January 2008 and exhibited the less dramatic symptoms of Marburg. Tests for Marburg came back negative, but she was retested six months later at her own request and Marburg was confirmed, both then and in the original sample. (It seems the CDC has a big freezer.)

On January 22, 2009, CDC notified the World Health Organization and Uganda Ministry of Health of the imported MHF case. The Python Cave had already been closed to visitors in July 2008, during the response to the Dutch MHF case. CDPHE and CDC conducted a public health investigation during January--February 2009. Interviews were conducted with the patient and her spouse, the patient's medical records were reviewed, and a retrospective contact investigation was conducted to identify possible secondary transmission. A contact was defined as a person who had physical contact with the patient, her body fluids, or contaminated materials or was in the same room as the patient during her acute illness (January 4--19, 2008). Contacts included health-care workers (including health-care providers, housekeeping staff, and hospital laboratory staff), commercial laboratory staff, and social contacts.

No explanation for the six month delay in reporting to the WHO was provided, nor for the further year it took this information to appear on the CDC site. One imagines that it may be due to the fact that the victim, though now recovered, was quite ill with Marburg, including eleven days of hospitalization in "a community hospital," and no notable precautions were taken. The story has medical thriller written all over it. Or perhaps the bird flu/H1N1 story was considered to be enough for the public to panic about at the time.

PlagueBlog recommends against bat-cave tourism of any sort, locally or in Africa.

Tis the Season

It's time again for ProMED-mail's Internet-a-thon. You can make donations at their website.

Non-Plushy Giant Virus

Via twitter: the AFP reports that French scientists have discovered a (non-plushy) giant virus.

With a genome of 368,000 basic pairs, Marseillevirus is the fifth biggest virus ever sequenced and has a diametre of 250 nanometres (around 250 millionth of a millimetre, according the a report by Raoult's for the French National Centre for Scientific Research (CNRS).
The DNA of the giant virus contains material from different sources including plant and animal matter, bacteria and other giant viruses such as the Mimivirus, the report said.
"There is a mechanism of permanent creation going on in amoeba producing a new repertoire of viruses and predisposing giant viruses to become pathogens once they specialise", Raoult said.

Some interesting statements about Darwin follow, which one hopes are merely mistranslated.

Microevolutionary Defenses against Kuru

Via Twitter: Razib at ScienceBlogs reports on cannibals, kuru, and microevolution.

127V is extremely efficacious against fatality due to kuru. Looking through the pedigrees in a region of very high kuru exposure the researchers found that of the individuals who carried 127V, only 1 out of 36 in the parent generation died of kuru. By contrast, 33 of 218 parents from those carrying 127G only (the modal allele) had died of kuru (some of these presumably would also have carried the protective variant of 129). When the researchers looked at the 127V haplotype, the nature of the variation around this mutation implied that a common ancestor existed ~10 generations ago, with a 95% confidence interval 7 to 15 generations. That means that all of the copies of 127V extant today in the Fore descend from one particular copy present on the order of 250 years in the past within the population.

Double Dipping

Via ProMED-mail: the Charleston Daily Mail reports on a pediatrician who came down with swine flu twice.

Parsons says she's spoken with CDC representatives about the results, and they said the double infection isn't all that unbelievable.
"They said this happens every year with seasonal flu, so there's no reason to expect that it wouldn't happen with swine flu," Parsons said. "Every flu strain can change a little bit."
The pediatrician says there may have been a tiny change in the virus that stopped her immune system from recognizing it or her body never built up immunity to it.

Iron and MS

Via Twitter: The Globe and Mail reports on a researcher's personal obsession that led to an unexpected treatment for multiple sclerosis.

Fighting for his wife's health, Dr. Zamboni looked for answers in the medical literature. He found repeated references, dating back a century, to excess iron as a possible cause of MS. The heavy metal can cause inflammation and cell death, hallmarks of the disease. The vascular surgeon was intrigued – coincidentally, he had been researching how iron buildup damages blood vessels in the legs, and wondered if there could be a similar problem in the blood vessels of the brain.
Using ultrasound to examine the vessels leading in and out of the brain, Dr. Zamboni made a startling find: In more than 90 per cent of people with multiple sclerosis, including his spouse, the veins draining blood from the brain were malformed or blocked. In people without MS, they were not.
He hypothesized that iron was damaging the blood vessels and allowing the heavy metal, along with other unwelcome cells, to cross the crucial brain-blood barrier. (The barrier keeps blood and cerebrospinal fluid separate. In MS, immune cells cross the blood-brain barrier, where they destroy myelin, a crucial sheathing on nerves.)
More striking still was that, when Dr. Zamboni performed a simple operation to unclog veins and get blood flowing normally again, many of the symptoms of MS disappeared.

BU's Leaky Biolabs

Via ProMED-mail: the Boston Globe reports on another BU researcher who accidentally brought his work home with him.

The genetic tests, conducted at the state laboratory in Jamaica Plain, compared a blood sample from the researcher with bacterial matter recovered from the lab where he was working on BU’s South End campus. “The bottom line,’’ said Dr. Anita Barry, top disease tracker at the Boston Public Health Commission, “is they matched.’’
The analysis erased any doubt about what caused the researcher to become sick last month and intensified investigations into precisely how he was exposed to a germ known as Neisseria meningitidis, which can cause meningitis.
The city’s biological lab safety division will review safety procedures in BU’s medical labs, to ensure that the school is doing everything possible to minimize researchers’ exposure to pathogens, Barry said.

I thought they did that last time.

PlagueBlog recommends moving to the suburbs before the new BU biolab opens downtown. And by "suburbs" I mean Maine.

Accidental Vaccinia

Via ProMED-mail: the CDC reports on a case of vaccinia infection in an immunocompromised woman who handled rabies vaccine bait, in which a genetically modified version of variola's little sister is used. There's much more on the story and the history of vaccinia at ScienceBlogs.

Atypical Scrapie

Via ProMED-mail: the New Zealand Ministry of Agriculture and Forestry reports on a case of atypical scrapie.

MAFBNZ Principal International Adviser Dr Stuart MacDiarmid says global knowledge about atypical scrapie/Nor 98 is evolving. The widely accepted mainstream scientific view is that it occurs spontaneously or naturally in very small numbers of older sheep in all sheep populations around the world.
"This positive detection of atypical scrapie/Nor 98 in a sheep from New Zealand's national flock reinforces that view. Every country that has conducted sufficient surveillance for atypical scrapie/Nor 98 has found it in their flocks. This includes most Scandinavian and EU countries, the UK, the USA and Canada," he says.
The detection does not change New Zealand's status as free from scrapie.

Mad Elk and Mad Fish

Via ProMED-mail: last month, the New York Times reported on the spread of CWD among elk via fecal-oral transmission, due to preclinical shedding of prions.

Dr. Aiken said prions tended to bind to clay in soil and to persist indefinitely. When deer graze on infected dirt, prions that are tightly bound to clay will persist for long periods in their intestinal regions. So there is no chance chronic wasting disease will be eradicated, he said. Outside the laboratory, nothing can inactivate prions bound to soil. They are also impervious to radiation.

Also, Practical Fish Keeping reported last month on a study of mad cow and scrapie transmissibility to fish:

The authors found that while the bream never displayed clinical signs of spongiform encephelopathies during the study period, the brains of TSE-fed fish sampled two years after challenge showed signs of neurodegeneration and accumulation of deposits that reacted positively with antibodies raised against sea bream PrP. The control groups, fed with brains from uninfected animals, showed no such signs.

Swine Flu Shots vs. Seasonal Flu Shots

Via ProMED-mail: temperatures are still high in Canada, where the Globe and Mail reports that two and a half provinces have rebelled against seasonal flu shots in reaction to as-yet-unpublished research showing that a seasonal flu shot makes people more susceptible to swine flu.

The hodge-podge of vaccination strategies comes after a controversial, unpublished study suggested that people under 50 are twice as likely to contract the H1N1 virus if they have received a seasonal flu shot compared to unvaccinated people.
With no data revealing the optimal way of rolling out vaccines against the looming double threat of seasonal flu and the pandemic swine flu virus, the abrupt changes by provinces and territories could create disarray in inoculation programs, with fewer people turning up for either shot, potentially resulting in more cases of severe illness.
New Brunswick's public health authorities, skeptical about the science behind the Canadian study, have moved up seasonal flu shots for all their residents to October before proceeding to the pandemic vaccine campaign. Meanwhile, Quebec and Nunavut are deferring their seasonal flu campaigns until after their H1N1 mass vaccination clinics.

Shaken Baby Syndrome

Radley Balko at Reason Online reports on growing doubts about "shaken baby syndrome":

The phrase shaken baby syndrome entered the pop culture lexicon in 1997, when British au pair Louise Woodward was convicted of involuntary manslaughter in the death of Massachusetts infant Matthew Eappen. At the time, the medical community almost universally agreed on the symptoms of SBS. But starting around 1999, a fringe group of SBS skeptics began growing into a powerful reform movement. The Woodward case brought additional attention to the issue, inviting new research into the legitimacy of SBS. Today, as reflected in the Edmunds case, there are significant doubts about both the diagnosis of SBS and how it's being used in court.
In a compelling article published this month in the Washington University Law Review, DePaul University law professor Deborah Teurkheimer argues that the medical research has now shifted to the point where U.S. courts must conduct a major review of most SBS cases from the last 20 years. The problem, Teurkheimer explains, is that the presence of three symptoms in an infant victim—bleeding at the back of the eye, bleeding in the protective area of the brain, and brain swelling—have led doctors and child protective workers to immediately reach a conclusion of SBS. These symptoms have long been considered pathognomic, or exclusive, to SBS.

If you're really interested, you can dig up some ideas about alternate causes of SBS at this blog.

Mattel Exempted Itself from Lead Testing

Via Purple Pawn: The LA Times reported late last month that Mattel had lobbied itself out of third-party lead testing of its products.

"It's really ironic that the company that was a principal source of the problem" is now getting favorable treatment from the government, said Michael Green, executive director of the Center for Environmental Health in Oakland.
Mattel is getting a competitive advantage, Green said, because smaller companies must pay independent labs to do the tests. Testing costs can run from several hundred dollars to many thousands.

Medical Isotope Shortage

Via Orthoprax: the Journal of the American Medical Association reports on the ongoing "critical" shortage of medical isotopes (^99mTc) due to a reactor shutdown in Canada.

The shortage was expected to be exacerbated by the temporary closing of the Netherlands reactor for a month-long maintenance inspection from July 18 to August 18. Because the isotopes have a relatively short half life, they cannot be stockpiled.
Canadian authorities said they were working with medical isotope distributors and others to maximize the use of existing isotope supplies and with other international producers to increase isotope production and to coordinate shutdowns and other operations.

Since the journal article was written, the reopening of the Ontario reactor has been pushed into 2010, causing some trouble for the company that sells the isotopes, the Canwest news service reports:

Life sciences company MDS Inc. said Wednesday it has agreed to sell its analytical technologies division to Danaher Corp. for $650 million in cash and is also looking to unload its pharma business.
The Mississauga, Ont.-based company cited the recession and the prolonged shutdown of the National Research Universal reactor in Chalk River, Ont., as its reasons for the sales, which will allow MDS to focus on its isotope business, MDS Nordion.
Stephen DeFalco, chief executive at MDS, said the company still expects the reactor to restart in spring 2010.

A Cure for MS?

Via a mailing list: Science Daily reports that multiple sclerosis has been reversed in mice.

The new treatment, appropriately named GIFT15, puts MS into remission by suppressing the immune response. This means it might also be effective against other autoimmune disorders like Crohn's disease, lupus and arthritis, the researchers said, and could theoretically also control immune responses in organ transplant patients. Moreover, unlike earlier immune-supppressing therapies which rely on chemical pharamaceuticals, this approach is a personalized form of cellular therapy which utilizes the body's own cells to suppress immunity in a much more targeted way.
GIFT15 was discovered by a team led by Dr. Jacques Galipeau of the JGH Lady Davis Institute and McGill's Faculty of Medicine. The results were published August 9 in the prestigious journal Nature Medicine.
GIFT15 is composed of two proteins, GSM-CSF and interleukin-15, fused together artificially in the lab. Under normal circumstances, the individual proteins usually act to stimulate the immune system, but in their fused form, the equation reverses itself.

A caveat: this appears to be an early-stage treatment that may not reverse existing damage to the nerves.

Not Your Grandfather's Influenza After All

Via ProMED: News1130 reports that swine flu may not be coming back in a more virulent form in the fall, because the Spanish Flu may not have done so.

Virologist Dr. Jeffery Taubenberger, along with co-author and medical historian Dr. David Morens, argues there is no firm evidence that the 1918 virus ratchetted up in virulence in a fall wave - because there is no solid proof outbreaks of illness in the U.S. in the spring of 1918 were caused by the same virus.
Their commentary, published in this week's issue of the Journal of the American Medical Association, suggested changes in virulence or transmissibility of the current pandemic virus are not inevitable. In fact, they wrote, there are reasons to hope for "a more indolent pandemic course and fewer deaths" than seen in many previous pandemics.

Superbug Enzyme in Britain

Via an unnamed source: the BBC reports on a new "superbug" in the UK, a shared antibiotic-eating enzyme imported from India.

The enzyme, called New Delhi Metallo-1, has so far been found attached to bacteria that has caused urinary tract infections and respiratory infections.
It is of particular concern because it can jump from one strain of bacteria to another meaning it could attach itself to more dangerous infections that can cause severe illnesses and blood poisoning making them almost impossible to treat.
The NDM-1 enzyme destroys a group of antibiotics called carbapenems which are mainly used in Britain for severe infections and are tightly controlled because they are one of the few groups of antibiotics that remain useful against bacteria that have already developed resistance to the commonly used drugs.

Plague in China

Via an unnamed source: the BBC reported last week on the rising plague death toll in China.

A BBC correspondent in Beijing, Michael Bristow, says that unlike in the past the authorities are being very open about this outbreak.
Local officials in north-western China have told the BBC that the situation is under control, and that schools and offices are open as usual.
But to prevent the plague spreading, the authorities have sealed off Ziketan.

Today the WHO reported on the situation, which seems to be under control:

According to the epidemiological investigation, the source of this outbreak was a wild marmot, which had contact with the dog of the index case. Ziketan is in an area of natural plague bacteria circulation amongst animals and at the present time it is the active season for plague transmission amongst animals. No drug resistance of the bacterium has been found so far and the 3 death cases have been attributed largely to delayed treatment.

Beware the Bitter Lupini

Via ProMED-mail: the Brisbane Times reports on two cases of lupini bean poisoning in Australia.

They suffered blurred vision, light-headedness, lethargy and had difficultly walking.
"Fortunately, neither of the two women who presented to hospital became seriously ill," says Nevada Pingault, an epidemiologist at WA Health's Communicable Disease Control Directorate.
"But lupin poisoning can be fatal."
An investigation revealed a quantity of bitter lupins had been milled into flour to meet a local shortage in supply.

Flu Ship

On the Typhoid Traveller front, via an unnamed source, the BBC reported on Friday that large numbers of crew on a cruise ship in the south of France were suffering from a flu-like illness.

It has now gone on to Marseille. The authorities there say neither passengers nor crew will be allowed to disembark until further tests have been carried out on their health.
"Based on the results, a decision will be made on whether or not passengers can disembark," a statement from the local prefecture, or local government, said.

Refrigerate After Opening

Via twitter: Wired reports on a company that's making beer from Eocene yeast recovered from amber.

Lambert and Cano had toyed with the idea for 12 years. Before Ambergene went under, the company made a batch on a lark. "We called it Jurassic Amber Ale or T-Rex Lager or something, and it was pretty good," Cano says. It was served at his daughter's wedding, and they even sent some to the Jurassic Park 2 cast party. That experiment had Cano and Lambert itching to release a beverage commercially. But they wanted it to be something respectable.

Needless to say, PlagueBlog recommends against eating anything that's over 40 million years old. In fact, only under the most extraordinary circumstances should you eat anything over 4 years old.

Fido Fricassee

ProMED-mail reports five recent cases of trichinosis "due to consumption of stray dog meat," with a total of nine cases this year.

PlagueBlog recommends against eating housepets, and especially not strays. You don't know where they've been.

Rabid Foxes

Via an unnamed source: WBZ reported a rabid fox attack Tuesday in Worcester. The victim was a 76-year-old woman who'd been gardening. The good Samaritan who held off the fox until the police shot him was also bitten. The fox was apparently known to police:

They believe this was the same fox that had been seen in the neighborhood the night before. One man was bitten, and two cats were also attacked.

There was a similar fox showdown in Pennsylvania in May.

More Recalls

Via an unnamed source: WBZ reports that Dunkin Donuts is temporarily cutting off the Dunkaccinos due to salmonella contamination at their chocolate supplier.

Via twitter: the AP reports that Shaws, Star, and Big Y are recalling some tuna steaks sold last week due to histamine.

Symptoms may include tingling or burning sensation in the mouth, rash on the face and upper body, hives and itching of skin, nausea, vomiting or diarrhea.

Don't Flu Party

Via an unnamed source: British doctors feel the need to warn people against holding flu parties. Flu partiers want immunity while the virus is still mild, but doctors there are instead trying to contain the outbreak.

Update (July 1st): Schott's Vocab also covers "vigilante vaccination."

Where's the beef?

I went to see Food, Inc. with my unnamed sources last week, and one of them has already found a topical CNN report of yet another E. coli recall.

The beef products were produced on April 21 and were distributed nationally and internationally, the USDA said. Boxes of the recalled product bear the establishment number "EST. 969" inside the USDA mark of inspection, the identifying package date of "042109" and a time stamp ranging from "0618" to "1130," the statement said.
It added that some of the beef products might have undergone further processing and might not have the "EST. 969" marking on products for sale directly to consumers.
The USDA urged customers with concerns to contact their point of purchase of the beef products.

In other words, God only knows whether the smoking beef is in your freezer right now.

E. coli Cookie Update

Thanks to an unknown source for yesterday's CDC update to the E. coli cookie dough situation:

As of Monday, June 22, 2009, 70 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 30 states. Of these, 41 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (5), Connecticut (1), Delaware (1), Georgia (1), Hawaii (1), Iowa (2), Illinois (5), Kentucky (3), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (2), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia (2), Washington (5), and Wisconsin (1).

As advised by the CDC, PlagueBlog reminds you that you should not eat raw food products that are intended for cooking or baking before consumption, no matter how yummy they may appear.

The Pandemic in Boston

Declared a pandemic on Thursday, swine flu has already claimed its first casualty outside the Americas and its first death in Massachusetts.

On the bright side, at least we aren't warehousing the ill in a tent camp on Summit Hill...yet. (Massachusetts news via Universal Hub.)

Flu Mask

Via GeekPress: a mask spotted by Movin' Meat.

The Smoking Bat

Via ProMED-mail: SciDev.Net reports on a study tracing the 2007 Ebola outbreak in the Congo to the consumption of fruit bats.

For the new study, researchers led by Eric Leroy from the International Centre for Medical Research in Franceville, Gabon, interviewed locals about the background of the Ebola cases. They were told that the annual migration of the fruit bat Hypsignathus monstrosus was particularly large in 2007.
Bats are an important source of protein in the area as wild animals are in short supply. They are often shot and then sold covered in blood.
The researchers believe the source of the 2007 outbreak was a man who bought bats at market. He survived, experiencing only a low fever, but his four-year-old daughter died after developing a sudden fever accompanied by vomiting. A family friend who prepared the girl's body for burial was subsequently infected and went on to infect 11 members of her family, all of whom died.

Swine Flu VII: Already a Pandemic

Via ProMED-mail: Bloomberg.com reports that novel influenza A (H1N1) has already met the WHO's vacillating standards for a flu pandemic, and has also been vastly underreported.

One in 20 cases is being officially reported in the U.S., meaning more than 100,000 people have probably been infected nationwide with the new H1N1 flu strain, according to the Centers for Disease Control and Prevention. In the U.K., the virus may be 300 times more widespread than health authorities have said, the Independent on Sunday reported yesterday.

Most disturbing are the prospects for ongoing summer transmission:

“While we are seeing activities decline in some areas, we should expect to see more cases, more hospitalizations and perhaps more deaths over the weeks ahead and possibly into the summer,” Anne Schuchat, CDC’s interim deputy director for science and public health program, told reporters on a May 22 conference call.

Popcorn Lung Update

"Diacetyl, the chemical that makes food taste like artificial butter flavor" [The Pump Handle] is back in the news, with a not-so-open-to-the-public OSHA meeting of the SBREFA panel. The future of diacetyl use in the food industry remains unclear.

Wikipedia has more on Bronchiolitis obliterans or popcorn lung. The tale of the single civilian victim appeared previously on PlagueBlog. (PlagueBlog recommends against eating your weight in artificially-flavored popcorn in any given year.)

Vaccinia: An Adverse Event

Via ProMED-mail: the CDC reports* on an adverse event following military smallpox vaccination. The patient survived, though the linked report may cause the reader to doubt that he would, or would want to.

Progressive vaccinia (PV), previously known as vaccinia necrosum, vaccinia gangrenosum, or disseminated vaccinia, is a rare, often fatal adverse event after vaccination with smallpox vaccine, which is made from live vaccinia virus (1). During recent vaccination programs potential cases of PV were investigated, but none met standard case definitions (2). PV has not been confirmed to have occurred in the United States since 1987 (3). On March 2, 2009, a U.S. Navy Hospital contacted the Poxvirus Program at CDC to report a possible case of PV in a male military smallpox vaccinee. The service member had been newly diagnosed with acute mylegenous leukemia M0 (AML M0). During evaluation for a chemotherapy-induced neutropenic fever, he was found to have an expanding and nonhealing painless vaccination site 6.5 weeks after receipt of smallpox vaccine. Clinical and laboratory investigation confirmed that the vaccinee met the Brighton Collaboration and CDC adverse event surveillance guideline case definition for PV (4,5). This report summarizes the patient's protracted clinical course and the military and civilian interagency governmental, academic, and industry public health contributions to his complex medical management. The quantities of investigational and licensed therapeutics and diagnostics used were greater than anticipated based on existing smallpox preparedness plans. To support future public health needs adequately, the estimated national supply of therapeutics and diagnostic resources required to care for smallpox vaccine adverse events should be reevaluated.

* Keep in mind that this is PlagueBlog. When I say adverse, I mean adverse. Click at your own risk.

Rabies Pandemic Brewing in Arizona

Via ProMED-mail: National Geographic reports on a more virulent strain of rabies brewing in Arizona.

Evolving faster than any other new rabies virus on record, a northern-Arizona rabies strain has mutated to become contagious among skunks and now foxes, experts believe.
The strain looks to be spreading fast, commanding attention from disease researchers across the United States.
It's not so unusual for rabid animals to attack people on hiking trails and in driveways, or even in a bar—as happened March 27, when an addled bobcat chased pool players around the billiards table at the Chaparral in Cottonwood.
Nor is it odd that rabid skunks and foxes are testing positive for a contagious rabies strain commonly associated with big brown bats.
What is unusual is that the strain appears to have mutated so that foxes and skunks are now able to pass the virus on to their kin—not just through biting and scratching but through simple socializing, as humans might spread a flu.
Usually the secondary species—in this case, a skunk or fox bitten by a bat—is a dead-end host. The infected animal may become disoriented and even die but is usually unable to spread the virus, except through violent attacks.

Swine Flu VI: A Vaccine

Via ProMED-mail: as this flu season draws to a messy end, Scientific American blogs about the prospects for a swine flu (Influenza A H1N1 etc.) vaccine for next season. Reuters reports that the WHO is optimistic about such a shift, although it is unclear what impact swine flu will have on regular seasonal flu vaccine production.

Marie-Paule Kieny, WHO director of the initiative for vaccine research, said the agency is discussing with drug companies whether and when to stop making seasonal flu vaccine production and shift to making one for the new H1N1 strain.

See my twitter updates for the latest swine flu news.

Swine Flu V: Sequence Analysis

Via ProMED-mail: sequence analysis indicates that swine flu may be entirely domestic and porcine, despite previous reports linking it to human and bird flus as well as Asian swine flu strains.

"...the NA and M genes are most closely related to corresponding genes from influenza viruses isolated in swine population in Eurasia."
However, the NA and M genes from 2 swine virus isolates from America are also closely related to the novel H1N1 virus (A/swine/Virginia/670/1987, A/swine/Virginia/67a/1987), if a reasonable nucleotide substitution rate is accepted. Thus, H1N1 from Mexico may be a swine flu virus strain of entirely American origin, possibly even of relatively ancient origin.

Swine Flu IV: The Return of the Typhoid Traveller

Via Healthmap on Twitter: ABC Australia reports on the search for fellow passengers of three New Zealander students with swine flu.

There are more updates on the pig farming connection, Israel's cases, Connecticut's suspected cases, and California's deaths and state of emergency in my twitter feed.

Swine Flu III: Mexico Timeline

Via Effect Measure by way of The Pump Handle: the blog Biosurveillance reports on Veratect's extensive timeline of swine flu in Mexico, starting with an incident in Canada on March 30th.

At Veratect, we operate two operations centers based in the United States (one in the Washington, DC area and one in Seattle, WA) that provide animal and human infectious disease event detection and tracking globally. Both operations centers are organizationally modeled after our National Weather Service using a distinct methodology inspired by the natural disaster and meteorology communities. Our analysts handle information in the native vernacular language and have been thoroughly trained in their discipline, which include cultural-specific interpretation of the information.
[...]
March 30
Veratect reported that a 47-year-old city attorney for Cornwall was hospitalized in a coma at Ottawa General Hospital following a recent trip to Mexico. Family members reported the individual voluntarily reported to the hospital after gradually feeling ill upon returning from his trip on 22 March.

Of special note are the pig farming connection on April 6th, the Semana Santa [Holy Week] connection under the heading "Large mass gatherings", and Veratect's new Twitter feed.

Swine Flu II

Although no pigs have become ill and no patients have reported contact with pigs, the new swine/avian/human influenza mix coming out of Mexico has been dubbed "swine flu." Since Mexican health officials first admitted the problem on Thursday, swine flu has been detected in California, Texas, Kansas, New York City, and Nova Scotia. Suspected cases are currently under investigation in British Columbia, France, Spain, Israel, and New Zealand, mainly in tourists returning from Mexico. No fatalities have been reported outside of Mexico (where the case count now stands at approximately 1500 with over 80 fatalities).

The Associated Press reports that the WHO has declared the outbreak in North America to be a "public health emergency" with "pandemic potential."

The CDC has a page up summarizing the current investigation.

A ProMED poster notes that like this one, the Spanish Flu first appeared at the end of the flu season, but came back with a vengeance for the next one:

The 1st cases of that agent showed up in May 1918 in an army base in Kansas -- it went quiet over the summer -- and started ravaging the globe in early fall that year.

Also, someone is maintaining a Google map of the outbreak.

Swine-Bird Flu

Via an unnamed source: The BBC reports on a rash of deaths in Mexico from a new strain of flu with both swine and bird elements.

Fifty-seven people had died in Mexico City from flu-like symptoms, [WHO spokeswoman Fadela Chaib] said, and another three in San Luis Potosi in central Mexico. There are around 800 suspected cases, she said.
Health Minister Jose Angel Cordova said the virus had "mutated from pigs and then at some point was transmitted to humans".
The strain of flu had been confirmed in at least 16 deaths, with 44 others being tested, the government said.
It urged people to take preventative measures such as not shaking hands or sharing crockery.
In the US, experts say the seven people who fell ill across two states were suffering from a new form of swine flu that combined pig, bird and human viruses.
"This is the first time that we've seen an avian strain, two swine strains and a human strain," Dave Daigle, a spokesman for the CDC, told AFP.
The CDC said none of the seven victims had been in contact with pigs, which is how people usually catch swine flu.

Norovirus Lockdown

Via an unnamed source: the Boston Globe reports that a norovirus outbreak has closed Babson College in Wellesley, Mass.

About 100 students have fallen ill since Wednesday. The decision to close the school was made [Sunday] after the virus escalated amongst the students, said Dr. Marcia Testa-Simonson, vice chair of the Wellesley Board of Health.
[...] The school is closed and students who live on campus are asked to stay on campus. The school is aiming to reopen Wednesday, said Mary Suresh, director of the Wellesley Health Department.

Scabies at Logan

Via an unnamed source: WBZ TV reports on a small scabies outbreak among TSA workers at Logan Airport in Boston.

TSA officials say all their workers wear gloves so the public should not be concerned about getting scabies.
It is still unclear how the employees got scabies in the first place.
According to the CDC, scabies is caused by an infestation of the skin by human itch mites that burrow under the skin and lay eggs.

It's unclear to PlagueBlog how the gloves that failed to protect the TSA workers are supposed to have protected the public.

90% Mortality Rates

Via ProMED-mail: The Hartford Courant reports a 90% mortality rate for the state's bats from white-nose syndrome.

Jenny Dickson, the Connecticut Department of Environmental Protection wildlife biologist supervising the detection and control of white-nose syndrome in the state, said Tuesday that visits to two sample caves in Litchfield County in the past two weeks revealed veritable bat catacombs. Dickson's team of wildlife experts found thousands of dead bats floating like dead fish in standing water, or stacked on top of each other along the flat ledges of the cave walls.
"It was grim, and you don't have to be a scientist to realize the implications for the environment inside those caves," said Dickson. "This is a massive, unprecedented die-off, with significant potential impacts on nature, especially insect control."

Bats from all over the Northeast migrate through Connecticut, so expect more mosquitoes this summer.

In other 90% mortality news, a German researcher pricked herself instead her intended mouse victim with a needle full of Ebola-Zaire last week. She's still in isolation, showing no symptoms and being treated with an experimental vaccine. See the AAAS blog for more information.

Norovirus in Massachusetts

Via Universal Hub: the Massachusetts Office of Health and Human Services reports a rise in norovirus infections in the state.

The Massachusetts Department of Public Health (DPH) has seen a significant number of gastrointestinal illness outbreaks across the state this winter, which are likely caused by norovirus infections. Noroviruses are a group of particularly strong viruses that cause nausea, vomiting, and diarrhea in people who get infected.
Noroviruses are easily spread through food, by person-to-person contact, or though contact with contaminated surfaces such as countertops and door knobs. The virus is spread through an infected person’s stool or vomit -- contamination that can be spread further without careful attention to hand washing and environmental cleaning.

There's a list of tips for avoiding infection, but they may not go far enough. In particular, PlagueBlog recommends avoiding dirty diapers and oysters altogether. There is no safe handling procedure for such items.

Cold on the Trail of the Tylenol Killer

Via Universal Hub: Boston.com reports that the FBI and state police searched a Cambridge condo today in connection with the 1982 Tylenol tampering deaths.

The first-floor condominium belongs to James W. Lewis, 62, of 170 Gore St., who spent 12 years in federal prison for trying to extort $1 million from the painkiller's manufacturers but was never charged in the murders. The authorities spent most of the day inside the six-story blonde brick building and also searched a storage facility at an undisclosed location in the city.
The Chicago office of the FBI said in a statement late today that agents, the Illinois State Police, and several local police departments were "conducting a complete review of all evidence developed in connection with the 1982 Tylenol murders," which prompted dramatic changes in the way almost all food and medical products are packaged.

Bubonic Justice

Via ProMED-mail: UPI reports that at least 40 al-Qaeda militants have died in a plague outbreak near Algiers.

Al-Qaida leaders said they fear the plague has spread to other cells or to Taliban fighters in Afghanistan.
The epidemic began in the hideouts of the al-Qaida in the Land of the Islamic Maghreb in Algiers, sources told The Sun. The group fled to Bejaia and Jijel provinces.

As they say, Allah hu Akbar.

Anthrax Redux

Via ProMED-mail: The New York Times reports on the life and spores of the late Dr. Bruce Edwards Ivins.

Focused for years on the wrong man, the bureau missed ample clues that Dr. Ivins deserved a closer look. Only after a change of leadership nearly five years after the attacks did the bureau more fully look into Dr. Ivins’s activities. That delay, and his death, may have put a more definitive outcome out of reach.
Brad Garrett, a respected F.B.I. veteran who helped early in the case before his retirement, said logic and evidence point to Dr. Ivins as the most likely perpetrator.
“Does that absolutely prove he did it? No,” Mr. Garrett said. With no confession and no trial, he said, “you’re going to be left not getting over the top of the mountain.”

And doubts will persist:

In November, four of Dr. Ivins’s closest co-workers wrote a glowing obituary of their “valued collaborator” for Microbe, the leading microbiology journal. It did not mention the anthrax accusations and was a singular protest by the four scientists against the F.B.I.’s conclusion.
“His colleagues and friends will remember him not only for his dedication to his work,” the obituary said, “but also for his humor, curiosity and great generosity.”

ProMED-mail Internet-a-thon

Like 2008 itself, the ProMED-mail 2008 Internet-a-thon is drawing to a close:

Your financial support enables ProMED to continue providing you and 48,000 others in 187 countries worldwide with reliable, independent reporting of emerging infectious diseases and outbreaks as they happen.

Plagueblog recommends that you support this noble cause.

Holiday Cookie Dough Warning

Via ProMED-mail: the New Zealand Food Safety Authority reports on a salmonella outbreak apparently caused by (raw) contaminated flour.

“It is possible for low levels of bacteria to be on wheat or other points of the flour milling process, and studies indicate that about one percent of flour on average contains Salmonella.”
“Flour is a raw ingredient and intended to be consumed cooked. Although flour is not expected to be a sterile product, we support the company’s precautionary decision to withdraw the product. The affected batches of these brands can be safely used to cook if proper care is taken. If people have used these brands in their baking - for biscuits, cakes, breads or other Christmas treats - they can be reassured that the cooking will have killed the bacteria and that these home baked foods are safe to eat.”

In other words, bake those cookies before you eat any.

Hog Ebola

Via ProMED-mail: Bloomberg reports on the discovery of Ebola Reston in Philippine hogs.

International scientists will converge on farms in the Philippines to help local authorities discover how pigs contracted Ebola-Reston, a monkey-killing strain not known to harm people. The findings may help identify which species carries the virus in the wild without getting sick, enabling the pathogen to persist undetected in the environment, said Juan Lubroth, head of infectious diseases in the animal health unit of the Food and Agriculture Organization in Rome.

Note that bats, those flying rodents of death, are still the main suspects for filovirus reservoirs. Ebola Reston first came to Reston, Virginia in Philippine monkeys, but this is the first known occurrence of Ebola in pigs. Ebola Reston is not believed to be harmful to humans.

Goo-Goo Melamine, Part VII

Via What to Eat: the New York Times reports that China now estimates the infant melamine scandal at about 300,000 cases with 6 dead. The previous estimate was 50,000 cases with 4 dead.

The Ministry of Health issued a statement saying that 860 babies who drank tainted milk were still hospitalized with kidney or urinary-tract problems; 154 of those were described as being in serious condition. “Most of the sickened children received outpatient treatment only for small amounts of sand-like kidney stones found in their urinary systems, while a part of the patients had to be hospitalized for the illness,” the ministry said.

Goo-Goo Melamine, Part VI

Via ProMED-mail: the AFP reports that the FDA has issued a wider-ranging import alert for melamine-tainted Chinese "protein-containing products." This AP report provides more details:

Under the directive, FDA inspectors at U.S. ports of entry will detain foods from China made with milk and certain ingredients derived from milk. Importers must pay to have their products tested by an independent laboratory that meets FDA standards. Only products found to be melamine-free will be allowed into the country.
The order also applies to pet foods and some bulk protein products, the focus of a melamine recall in 2007.
Essentially, the FDA action shifts the burden of proof to Chinese companies, which must now supply evidence that their products are safe. Most consumers should not be affected, since major U.S. food manufacturers get their milk ingredients here.

Google Flu

Via Google Web Clips: Elizabeth Landau at CNN.com/health reports on a new Google tool, Google Flu Trends.

Google's new public health initiative, Google Flu Trends, looks at the relative popularity of a slew of flu-related search terms to determine where in the U.S. flu outbreaks may be occurring.
"What's exciting about Flu Trends is that it lets anybody -- epidemiologists, health officials, moms with sick children -- learn about the current flu activity level in their own state based on data that's coming in this week," said Jeremy Ginsberg, the lead engineer who developed the site.

See also the Official Google Blog for details.

NIH Blue Ribbon Panel Biolab Hearing

Via Universal Hub: there will be a hearing this Tuesday in Roxbury about the biosafety level 4 facility BU still hopes to build right next to a million Greater Bostonians. From the Federal Register:

There will be a meeting of the NIH Blue Ribbon Panel to advise on the Risk Assessment of the National Emerging Infectious Diseases Laboratories (NEIDL). The meeting will be held on Tuesday, October 14, 2008, at the Roxbury Center for the Arts, Hibernian Hall, 184 Dudley Street, Roxbury, MA 02119 from approximately 6:30 p.m. to 9:30 p.m.
Discussions will focus on principles and strategies for effective community engagement. There will also be time allotted on the agenda for public comment.
Sign up for public comment will begin at approximately 5:30 p.m. on October 14, 2008. In the event that time does not allow for all those interested to present oral comments, anyone may file written comments using the address below.
For further information concerning this meeting contact Ms. Laurie Lewallen, Advisory Committee Coordinator, Office of Biotechnology Activities, Office of the Director, National Institutes of Health, Mail Stop Code 7985, Bethesda, MD 208927985, telephone 3014969838, email lewallla@od.nih.gov. Background information may be obtained by contacting NIH OBA by email oba@od.nih.gov.
Dated: September 16, 2008.
Kelly R. Fennington,
Special Assistant to the Director, Office of Biotechnology Activities, National Institutes of Health.
[FR Doc. E822313 Filed 92208; 8:45 am]

ACE also promises a webcast at http://videocast.nih.gov.

A Plague of Bedbugs

Via Tech San: the UK Telegraph reports on a plague of bedbugs in Spain this September.

Convents and hostels along the route to the north-western Spanish city of Santiago de Compostela have become infested by bedbugs, spread by the more than 100,000 pilgrims who travel to the shrine of St James every
The insects, which bury themselves deep inside mattresses and pillows in the pilgrims' quarters, are causing untold numbers of travellers to have sleepless nights and are responsible for many falling ill on the way.
The Federation of Friends of the Camino de Santiago has proposed a simultaneous clean up at all overnight stops along the route from the town of Roncesvalles on the French border in the Pyrenees.
"It's a plague and it's incredibly dangerous," said Angel Luis Barreda from the organisation that oversees the pilgrimage path.

It's actually not the case that bedbugs nest in "deep inside mattresses and pillows." They prefer nooks and crannies in wood, from which they emerge at night when they detect the carbon dioxide emissions of sleeping humans.

Goo-goo Melamine, Part V

Although China claims its milk is no longer contaminated with melamine, the scandal continues to spread. Melamine-contaminated products have been found in Siberia, Germany, the Netherlands, Canada, and even Utah. The FDA has produced a safety/risk assessment for melamine. While unable to set a level for infants, they did provide one for adults:

In food products other than infant formula, the FDA concludes that levels of melamine and melamine-related compounds below 2.5 parts per million (ppm) do not raise concerns.

The BBC reports that several animals in a Chinese zoo near Shanghai were fed the contaminated milk powder for over a year:

Concerned keepers sent the animals for a check up after hearing about the milk contamination and have now stopped feeding with Sanlu milk.
The orang-utans and the lion are the only animals to have developed kidney stones and are being treated for the condition.
Officials at the Beijing Zoo and zoos in the other major cities of Shanghai, Guangzhou and Xian said they had no cases of animals sickened from milk powder, the Associated Press reported.

Goo-goo Melamine, Part IV

Via ProMED-mail: Radio New Zealand reports that the melamine crisis in China has spread to 53,000 infants, 13,000 of whom are hospitalized. Rumors reach back to December 2007, and the UN wants an explanation:

The World Health Organisation has asked the Chinese authorities to explain why it took months for the tainted milk scandal to be made public.
The UN children's agency UNICEF has asked Chinese authorities to launch a full investigation into the matter.

Goo-Goo Melamine, Part III

Via ProMED-mail: The melamine death toll has risen to 4 Chinese infants (or possibly five, according to The Daily Yomiuri). Melamine has now been found by several countries in imported milk, yoghurt, coffee, and candy. Several African countries have banned Chinese milk.

A Japanese company has recalled some snacks manufactured in China, and the FDA has stepped up inspections:

Leon said the FDA is sampling bulk shipments of milk-derived products from Asia for possible contamination with melamine or other banned ingredients. The products being tested include whole milk powder, whey powder, milk concentrate, lactose, casein protein, and other milk derivatives.

Goo-goo Melamine, Part II

Via ProMED-mail: The New York Times reports that China's latest melamine scandal has spread to 6,244 infants and 22 dairy companies. Xinhua News Agency reports:

The State Administration of Quality Supervision, Inspection and Quarantine said it had tested 491 batches of baby milk powder produced by all the 109 companies in the country in a special inspection move.
69 batches from 22 companies nationwide were found containing melamine, a chemical which had tainted Sanlu's baby formula and led to kidney stone illness of more than 1,200 infants across the country.
The number of companies with melamine-tainted milk accounted for 20.18 percent of the total of milk powder companies in China. And the number of tainted batches accounted for 14.05 percent of the total batches tested.
The melamine content in the Sanlu brand reached 2,563 mg per kg, the highest among all the samples. In other samples, the range was from 0.09 mg to 619 mg per kilogram.

Xinhua also reports that 10,000 tons of contaminated formula will be destroyed.

Goo-goo Melamine

Via ProMED-mail: the FDA has issued an advisory against infant formula from China. At least 14 Chinese infants became ill, and powdered formula produced by the dairy concern Sanlu was subsequently found to contain melamine.

In response to reports of contaminated milk-based infant formula manufactured in China, the U.S. Food and Drug Administration (FDA) today is issuing a Health Information Advisory. This is to assure the American public that there is no known threat of contamination in infant formula manufactured by companies that have met the requirements to sell infant formula in the United States. Although no Chinese manufacturers of infant formula have fulfilled the requirements to sell infant formula in the United States, FDA officials are investigating whether or not infant formula manufactured in China is being sold in specialty markets which serve the Asian community.
The FDA is advising caregivers not to feed infant formula manufactured in China to infants. This should be replaced with an appropriate infant formula manufactured in the United States as mentioned below.

The Xinhua News Agency reports that the smoking formula has been removed from the shelves in China:

Hundreds of Carrefour and Wal-Mart stores in China are pulling Sanlu milk powder off shelves.
The withdrawal came after both the health authority and Sanlu confirmed the milk to be contaminated with a toxic chemical.
Dong Yuguo, spokesman for Wal-Mart China, said on Friday the company received notices to stop selling the formula.
Xinhua's reporter did not find Sanlu milk powder on shelves in one of the Wal-Mart stores in the Xuanwu District, Beijing, Friday afternoon. The store staff said the brand was ordered to be withdrawn.
Wal-Mart now has 109 stores in China.

This is hardly the first melamine incident. I have added a melamine label for reader convenience, and am updating the China advisory to: PlagueBlog recommends avoiding any pharmaceuticals, infant formula, food, animal feed, or edible components thereof originating in China. And the inedible components, too.

A Potential Cure for Ebola

Via io9.com: PLoS reports on a potential cure for Ebola.

Here, we use a novel technology to measure penetration of Ebola virus into the cell in real time and show that Ebola virus stimulates phosphoinositide-3 kinase, a signaling molecule known to induce endocytosis. Importantly, drugs that interfere with this signaling inhibit infection by Ebola virus and block virus spread. This work provides a mechanistic insight into how Ebola virus manipulates the cell to start an infection, may explain part of virus induced pathogenesis, and provides a potential way to treat this deadly disease.

Pandemic Fiction

Via Futurismic: "Pandemic" by J. F. Bone is an old (1962) story from Analog about a pathologist working on a species-threatening pandemic with a new, grim (but still plucky) nurse. Copyright has apparently lapsed.

Generally, human beings don't do totally useless things consistently and widely. So--maybe there is something to it--
"We call it Thurston's Disease for two perfectly good reasons," Dr. Walter Kramer said. "He discovered it--and he was the first to die of it."

The Perils of Being a Disease Maven

Via ProMED-mail: The New York Times reports on the perils of being a bioterrorism expert--or even an amateur--when the FBI is on the prowl.

Another casualty was Kenneth M. Berry, an emergency room physician with a strong interest in bioterrorism threats. In August 2004, agents raided his colonial-style home and his former apartment in Wellsville, a village in western New York, as well as his parents’ beach house on the Jersey Shore.
In scenes replayed for days on local television stations, the authorities cordoned off streets as agents in protective suits emerged from the dwellings with computers and bags of papers, mail and books.
“He was devastated,” Dr. Berry’s lawyer at the time, Clifford E. Lazzaro, said in an interview. “They destroyed his marriage and destroyed him professionally for a time.”

Whole Foods and E. coli

Via Universal Hub: the Massachusetts Department of Health and Human Services reports that seven cases of E. coli in the state have been traced to ground beef from Whole Foods.

Officials from the supermarket chain have cooperated with staff from DPH during the agency’s investigation to determine the source of the contamination. Preliminary findings suggest that ground beef products that were previously identified as part of a nationwide recall may have entered the retail supply at Whole Foods during June and July.
Last month, the United States Department of Agriculture (USDA) announced the extension of a national recall for ground beef produced by Nebraska Beef, Ltd. due to possible E. coli contamination. Nebraska Beef produces products under the Coleman brand name, and a review of records from Whole Foods indicates that some of the stores received product from the recall list. At this time, it is not known why the food listed under the USDA recall was sold to the public after the recall date.

The state recommends throwing away any ground beef purchased at Whole Foods between June 2nd and August 6th.

The Mother of All Parasites

Via The Anti-Toxo: Future Microbiology reports the discovery of a missing-link apicomplexan and its implications.

Symbiosis and parasitism are thus wide-spread in both the dinoflagellates and apicomplexans, suggesting that modern parasites like Plasmodium spp. and Toxoplasma likely started out as mutualistic symbionts that initially nourished their animal hosts before turning to parasitism. These symbiotic/parasitic relationships thus extend back in evolutionary time to the earliest origins of the animals, which means that either as parasites or symbionts, these protists have been interacting with the animal immune system since its inception. As a consequence of this protracted dance, malaria parasites are exquisitely well-equipped to evade our immune system: a sobering harbinger for malaria vaccine prospects.

Prions are Forever

Via ProMED-mail: in June ScienceDaily reported on prions surviving waste water treatment.

Until now, scientists did not know whether prions entering sewers and septic tanks from slaughterhouses, meatpacking facilities, or private game dressing, could survive and pass through conventional sewage treatment plants.
Joel Pedersen and colleagues used laboratory experiments with simulated wastewater treatment to show that prions can be recovered from wastewater sludge after 20 days, remaining in the "biosolids," a byproduct of sewage treatment sometimes used to fertilize farm fields.

I suppose if you can get prions from squirrels, you can get them anywhere.

Adjustable Glasses

Via plime: The World Bank reports on the bright prospects of cheap, adjustable corrective eyeglasses with oil-filled lenses.

For too many of the world’s poorest people, life is just a blur. WHO estimates that roughly a billion people—mostly in developing countries—need eyeglasses to read, write, work, and go about their daily lives. But they cannot find them, let alone afford the high price tag. It can take as much as three months’ wages or more to afford glasses in many African countries.
At least 10 % of this group is made up of youngsters of school age.
These vision problems could eventually be corrected on a large scale through use of cheap, self-correcting spectacles, invented by Oxford University physicist Josh Silver, and being made by a British NGO for between $5–$10, with the ultimate target price being about $1 a pair.

The Achilles' Heel of HIV

Via plime: The Daily Texan reports on progress towards an HIV vaccine.

Along with fellow researchers, Paul has identified one region on the surface of the virus that is mostly unchanging. He explained that this small region is critical for the virus to bind to cells; without this section, the virus would not be able to infect the cells.
The UT researchers call this small region the "Achilles heel" of HIV, which causes AIDS.
"We identified this region as a suitable target for antibodies," Paul said.

On the dissent front (not that they intended it that way) Discover reports on a connection between schistosomiasis and HIV:

Schistosomiasis, seen primarily in developing countries, is caused by tiny flatworms that live in snail-infested freshwater like rivers and lakes. When people wade, swim or bathe in contaminated water, worms bore through the skin and travel in the blood, causing anemia, diarrhea, internal bleeding, organ damage and death.

HIV sounds like the least of their problems.

Beware of Green Food

Via Universal Hub: the FDA advises against the consumption of tomalley from Maine lobsters due to the risk of Paralytic Shellfish Poisoning (PSP).

The FDA advisory applies only to tomalley, the soft, green substance found in the body cavity of the lobster that functions as the liver and pancreas. Cooking does not eliminate the PSP toxins. However, studies have shown that, even when high levels of PSP toxins are present in lobster tomalley, lobster meat itself is typically unaffected.

Also on the green food watch, the CDC reports a couple of smoking jalapeños:

An FDA laboratory detected Salmonella Saintpaul with the outbreak strain fingerprint pattern in a sample of jalapeño pepper obtained from a distribution center in McAllen, Texas. The distributor is working with FDA to recall the contaminated product in the United States. The peppers were grown in Mexico; investigators are working to determine where they were contaminated.
The Laboratory Services Division of the Colorado Department of Public Health and Environment detected Salmonella Saintpaul with the outbreak strain fingerprint pattern in a jalapeño pepper provided by an ill individual. The state health department is working with the FDA to determine the origin of the jalapeño pepper.

Plagueblog recommends eating locally-grown produce (unless you are local to Mexico) and ruminants. In no case should you be eating any part of an animal whose internal organs can be described as a "soft, green substance [...] that functions as both liver and pancreas."

Rapamycin

Via Technovelgy:

Rapamycin, a drug approved by the FDA to stop tissue rejection after organ transplants, has been found to reverse the brain dysfunction caused by a genetic disease - tuberous sclerosis complex (TSC).
"This is the first study to demonstrate that the drug rapamycin can repair learning deficits related to a genetic mutation that causes autism in humans. The same mutation in animals produces learning disorders, which we were able to eliminate in adult mice," explained principal investigator Dr. Alcino Silva, professor of neurobiology and psychiatry at the David Geffen School of Medicine at UCLA. "Our work and other recent studies suggest that some forms of mental retardation can be reversed, even in the adult brain."

See Science Daily for more details.

Marburg Death in the Netherlands

Via ProMED-mail: the European Center for Disease Prevention and Control reports a Marburg death in Leiden, the Netherlands, of a woman who had recently visited the Maramagambo forest in Queen Elizabeth National Park, Uganda.

The patient died on July, 11.
ECDC’s initial assessment is that the threat to public health is limited and mainly focussed on the people who have been in close contact with the patient after the onset of her symptoms. People intending to travel to Uganda should be aware there may be a risk related to visiting caves in the Maramagambo forest.

PlagueBlog recommends New England as a safer travel destination than Uganda--as long as you keep out of the Muddy River.

A New Non-variant CJD

Via an unnamed source: the BBC reports the discovery of a new type of sporadic CJD (Creutzfeldt-Jakob disease).

Dr Pierluigi Gambetti, director of the US National Prion Disease Pathology Surveillance Center, in Ohio, said that he believed the newly discovered type had probably "been around for years, unnoticed".
He suggested one interesting common factor was that the patients came from families with a history of dementia, suggesting a genetic cause, but did not carry the gene traditionally associated with a small number of sporadic CJD cases.

Tomato Doubts

Via ProMED-mail: USA Today reports that the ongoing salmonella outbreak has led to doubts about the tomato theory:

At a news conference Friday, representatives of the FDA and the CDC were more forceful in saying that they aren't sure tainted tomatoes caused the outbreak of salmonella saintpaul, a fairly rare strain. Previous statements had been more vague.
Over the weekend, the tide of opinion among epidemiologists, produce companies and food safety officials also began to turn in that direction.
Tomatoes couldn't have caused an outbreak that has stretched from early April to late June, says Jim Prevor, editor of Produce Business magazine. "There's not a field in the world" that produces that long, he says.

No new smoking vegetable has been implicated.

Salmonella hits Massachusetts

Via ProMED-mail: The CDC reports that the Saintpaul [sic] salmonella strain has now been reported in Massachusetts, with twelve people affected.

Among the 316 persons with information available, illnesses began between April 10 and June 13, 2008. Patients range in age from <1 to 99 years; 50% are female. At least 69 persons were hospitalized. No deaths have been officially attributed to this outbreak. However, a man in his sixties who died in Texas from cancer had an infection with the outbreak strain of Salmonella Saintpaul at the time of his death. The infection may have contributed to his death.
Only 3 persons infected with this strain of Salmonella Saintpaul were identified in the country during the same period in 2007. The previous rarity of this strain and the distribution of illnesses in all U.S. regions suggest that the implicated tomatoes are distributed throughout much of the country. Because of inherent delays in reporting and because many persons with Salmonella illness do not have a stool specimen tested, it is likely many more illnesses have occurred than those reported. Some of these unreported illnesses may be in states that are not on today’s map.

The FDA has specific information on what tomatoes are safe to eat.

Parasites Unleashed

Via Boardgame News: Zygote Games has finally released Parasites Unleashed, a card game.

Become one of life's ultimate insiders! In PARASITES UNLEASHED! you control a wily parasite, racing to complete your life cycle, mate, and lay eggs before your opponents. Do all the entertainingly gross things real parasites do -- bore into vital organs, hide inside a blood cell, hitch a ride inside a mosquito, even take over your host's brain! But beware, because your enemies can add stages to your life cycle, and zap you with medicine!

Lactose Intolerance in Europe

Tthere's an article about lactose intolerance at Food Reactions, with a map showing the percentage of people with primary lactase deficiency (the genetic inability to produce the lactose-eating enzyme lactase) across Europe.

In a review by Gudmand-Hoyer E in published on The American Journal of Clinical Nutrition (1994), [primary lactose deficiency] is lowest in Scandinavia and Northwest Europe (3-8%) and close to 100% in most of Southeast Asia. In Europe the frequency increases in the southern and eastern directions, reaching 70% in southern Italy and Turkey. There is also a high prevalence of lactose maldigestion in the people of Africa with the exception of cattle-raising nomads. Moreover, studies conducted by Scrimshaw and Murray and Sahi review the prevalence of lactose maldigestion globally. The prevalence is above 50% in South America, Africa, and Asia, reaching almost 100% in some Asian countries.

If you look very carefully at the map, though, you will see that the rate of lactose intolerance reaches not just 70% in Sicily but a pan-European high of 81% just north of Napoli (around the lower calf of Italy, above the spur). This region is called Campobasso, and it's where I get my gene for hypolactasia.

Via ProMED-mail: the South Carolina Department of Health and Environment Control reports on a rabid raccoon that exposed sixteen people to rabies, because they wouldn't let Darwin be Darwin.

Sixteen people who were exposed to rabies by a raccoon are under the care of a physician after the raccoon tested positive for the disease, the S.C. Department of Health and Environmental Control said today.
"The baby raccoon was found in the woods and was being cared for by several people over the past several weeks," said Sue Ferguson of DHEC's Bureau of Environmental Health.
According to Ferguson, many of the exposures occurred when feeding the raccoon, as caretakers came into contact with the animal's saliva. Seven more people are being evaluated for possible exposure risk.

Biolab Follies

Via Universal Hub: the Boston Phoenix reports on BU's ongoing "Biolab Follies."

Throughout the past few years, and particularly during the past 12 months, the biolab’s backers have suffered a string of setbacks: legal, diplomatic, political. Boston University Medical Center (BUMC) may still end up hosting a BSL-4 facility, but this is hardly the sure thing it once was. In fact, given the current momentum of the debate, the smart money might actually be on the biolab not coming to fruition, at least as it was originally conceived.
So what went wrong, exactly? Or, for those who see things differently: what went right?

The story chronicles the political side of the biolab debate, with, perhaps, too much attention to race and too little to zombie protesters.

Heparin Tainting Deliberate

I found this report accidentally in a Parkinson's search, because the CEO of Baxter happens to be one Robert Parkinson. The Chicago Tribune reports that Parkinson called the contamination of its heparin supplies a "deliberate adulteration scheme" by suppliers in China. (PlagueBlog is shocked that such a thing could happen.)

The scale of the scandal over tainted heparin continued to expand. David Strunce, chief executive of Wisconsin-based Scientific Protein, acknowledged that the company has no way of knowing which of 12 different suppliers might have introduced foreign matter into the heparin supply chain. Strunce also claimed Chinese regulators have interfered with his company's efforts to investigate the matter.
The FDA has tallied more than 80 reports of deaths and more than 1,000 adverse events associated with patients in the U.S. who had one or more allergic reactions to heparin products, including those sold by Baxter, since Jan. 1, 2007.

As a result, the Chicago Tribune also reports, Baxter is considering getting out of the heparin business altogether:

The product generates $30 million of Baxter's more than $11 billion in annual sales, and Wall Street analysts asked Parkinson last week whether it was worth the legal risks and liability to remain in the business given that sales are so small.
"We haven't made a decision whether or not we are going to re-enter [the market] with heparin," Parkinson told analysts.

PlagueBlog recommends producing drugs, including their ingredients, domestically.

Rabies on the Cape

Via an unnamed source: the Cape Cod Times reports two cases of rabies in pet cats in the past two weeks.

The discovery of rabies in the cats has dire public health implications, local veterinary and natural resources officials said yesterday. They urged residents to make sure their cats, as well as dogs and ferrets, are vaccinated.
Cats are the "perfect bridge to human health," said Dr. Thomas Burns, president of the Cape Cod Veterinary Medical Association, who treated the Yarmouth cat.
Officials fear an unvaccinated house cat could contract rabies, pass it on to a person before exhibiting symptoms, then wander off and die in the wild. The person might not be aware of the infection, the officials said.

PlagueBlog fondly recalls the days when ferrets were illegal in Massachusetts and continues to recommend fish--the perfect pet and the perfect food.

Heavy Drugs

Via Universal Hub: Xconomy reports on a Lexington (Mass.) company that plans to build better drugs with deuterium.

Concert Pharmaceuticals may have found a way to help established drug substances pack a better punch. By substituting a few normal hydrogen atoms with the heavier form, deuterium, the company believes it is possible to create new chemical entities with greater efficacy and fewer side effects. And since these entities are based on proven drugs, the reasoning goes, it will probably take less time and money to take them to the market.