epidemiology
revere | April 26, 2009If there was ever a graphic illustration of how global interconnectedness affects public health, it's the swine flu affair. Wherever it started, the current crop of cases seems related to Mexico, either as the epicenter or via travelers. Four US states have cases. Those not on the Mexican border are related to travel to Mexico. Kansas, New York City, the suspect cases in secondary school teachers and students in Auckland, New Zealand just returned from Mexico. And France has two suspect cases also just returned from Mexico, as does Spain. We've discussed the problem of infectious disease on…
revere | April 25, 2009A concise summary of some additional developments, courtesy Bloomberg:
Three teachers and 22 students from Auckland’s Rangitoto high school are being tested for swine flu after returning to New Zealand’s most populous city from Los Angeles following a three week trip to Mexico, Stuff.co.nz reported on its Web site. Some of the travelers had symptoms of flu-like illness and were being isolated as a precaution pending test results, it said, citing the Auckland’s public health service.
In the U.K., a British Airways Plc crewmember with flu-like symptoms was taken to Northwick Park Hospital…
revere | April 25, 2009There may not have been much news at the CDC briefing, but it is coming thick and fast now. The CDC works through state health departments and defers to them on information about what is going on in their localities. Hence all questions about this were deflected at the 1 pm CDC briefing. I think I understand the thinking behind this but it doesn't serve the goal of getting the information out there quickly. CDC needs to be the information clearing house for all the swine flu news going on around the country and they need to do with absolute transparency. Here's what has developed since that…
revere | April 25, 2009CDC has just concluded a press briefing and the big news is there is no big news. In fact there was hardly any small news. The major questions have been identified -- how transmissible, what is the epidemic curve, are there more cases in the US, are there subtle genetic differences in the US and Mexican versions to account for the apparent difference in clinical and epidemiological features, etc. -- but answering them will take longer.
Meanwhile, no new cases have been identified in the US, but CDC in collaboration with state and local health departments and the academic and medical sectors…
revere | April 25, 2009There will be an update from CDC later today and WHO's expert committee established under the new International Health Regulations (IHR) meets via teleconference this morning North American east coast time at 10 am (4 pm Geneva time) to consider whether the swine flu situation merits declaring it “a public health event of international concern.” If they do, WHO Director General Margaret Chan may respond by raising the pandemic threat alert level from the current phase 3 (new virus: no or limited human to human transmission) to phase 4 (new virus, evidence of increased human to human…
revere | April 24, 2009Some end-of-the day (but not end-of-the-world) bits and pieces in the emerging swine flu story.
From Helen Branswell (Canadian Press):
In Mexico, Secretary of Health Jose Angel Cordova Villalobos said in a television interview that there have been 45 deaths, but only 16 of those were directly related to the flu in question.
An estimated 943 people are ill, the television report said.
The majority of the cases are occurring in young, previously healthy adults in their mid 20s to mid 40s, reports suggest. Experts aren’t certain if all of those people are sick with this virus or if other flu or…
revere | April 24, 2009Two recent sources of information, a conference call for clinicians and a just concluded media conference call held by CDC Acting Director Richard Besser.
Clinician call:
An emergency conference call for the Clinician Outreach and Communication Activity (COCA) was announced just hours ago on the Clinicians Terrorism and Emergency Preparedness listserv. It was "live blogged" via the Comments Thread by reader Abigail, MD. Here's the gist (lightly edited), as typed by her in real time (thanks!):
Update on current emergency situation - 8 individuals in US with swine flu, the hospitalized patient…
revere | April 23, 2009This afternoon CDC held a "media availability" on the evolving swine flu cases. Evolving is an understatement. There are now more recognized cases, although not all cases are "new," with some cases retrospectively recognized now that more intense investigation is occurring. The total is now seven cases. Two occurred in San Antonio, Texas, two sixteen year old boys in the same school. Three more were found in California (in addition to the initial two cases), including a father - daughter pair. All California cases are in San Diego and neighboring Imperial counties, the location of the initial…
ddobbs | April 20, 2009Who stands most at risk of PTSD? A new study of PTSD in US veterans of the current Iraq and Afghanistan wars suggests that you can identify the most vulnerable -- soldiers who stand 2 to 3 times the risk of their peers -- with fairly simple measures of mental and physical health.
The study, conducted by the U.S. Navy's Tyler Smith and collegues, is part of an ongoing longitudinal study of over 150,000 U.S. soldiers. The Millennium Cohort Study began collected comprehensive health data on U.S. soldiers in 2001. This study draws on that data to compare health status before deployment to Iraq…
revere | April 17, 2009This year's flu season isn't over, but it's almost over, and it was fairly typical and much better than last year, which was nasty. It began at the end of September but didn't take off until early January, peaking in mid Februrary. New cases are still appearing but much less frequently and they are mainly influenza B, which tends to be milder than influenza A. Most of flu/A this year was also of the milder H1N1 sort, which probably contributed to the better outcomes. Here's where we are (source for all charts here):
Comparing this year with previous years shows it to be relatively typical of…
revere | April 15, 2009The Wall Street Journal (WSJ) calls it a "reality check," meaning, in their terms, a check against the mistaken idea that there is more foodborne illness these days. That's one way to look at it. Another is a look that is reality based. The reality is that there is a tremendous health burden from tainted food that is unaddressed, at least going by the same CDC Morbidity and Mortality (MMWR) report the WSJ was citing. MMWR was reporting on 2008 data from FoodNet on the incidence of infection from enteric pathogens commonly transmitted via food:
Despite numerous activities aimed at preventing…
revere | April 12, 2009Fomites are inanimate objects that act as modes of transmission for infectious agents. You know. The doorknob or airplane armrest handled by someone who coughs on his hand or blows her nose. We know that some agents, like influenza viral particles, can remain viable (i.e., retain their ability to replicate in a host cell) for days or weeks. This doesn't automatically mean that fomites are an important mode of transmission, however. There is evidence those same viral particles lose their ability to replicate after only a few minutes on your hand. The apparent paradox is probably related to the…
revere | April 9, 2009A tantalizing Reuters story yesterday called attention to the uptick in human bird flu cases in Egypt, the African country with more cases than any other (although far behind Asian countries like Indonesia). The observation prompting renewed expressions of concern are that new cases seem to be in the very young (toddlers) but adult cases have almost disappeared. So where are these toddlers picking up the virus? A possibility that is consistent with the observations is that adults are giving it to the toddlers but are themselves symptomless carriers. It's not impossible, because we know that…
revere | April 1, 2009We have a small dog in our house. She came to us from Mrs. R.'s elderly mother, who had decided that a dog would be a good companion. She lived alone in the city. She also had low vision, and within weeks she had already fallen over the frisky little pup who was constantly under foot. As a public health measure, we took the pooch, although we already had a dog of our own. That was seven years ago and Rosie remains a beloved member of the family. She discovered we were easily trainable, so that part went fine (for her). Now CDC has published a report verifying that the circumstances that…
revere | March 9, 2009I'm sure it will be years before we have cleaned up all the garbage -- literally and figuratively -- from the Bush administration's Environmental "Protection" Agency. The notoriously conservative DC Appeals Court, in a unanimous decision, did its part recently when it declared the Bush EPA's standards for air particulates “contrary to law and unsupported by adequately reasoned decisionmaking." The language doesn't get much stronger than that. Just a few days before the Supremes refused to hear a challenge to a lower court decision striking down Bush EPA mercury standards from coal-fired power…
revere | March 1, 2009The scientific literature is full of specialized papers that on their face would seem to be of little interest. Here's a title like that: "Prevalence and seasonality of influenza-like illness in children, Nicaragua, 2005-2007" (Gordon et al., Emerging Infectious Diseases 2009 Mar). Over 4000 Nicaraguan children, aged 2 to 11 years old and living in the capital of Managua were followed for 2 years, April 2005 to April 2007 and observed for development of ILI (influenza-like illness). We know a lot about influenza in major industrialized countries in the northern and southern temperate zones,…
sciencepunk | February 20, 2009
The Space Game might not have the most inspired title, but beneath the nondescript exterior lies a jewel of a real-time strategy game with some interesting quasi-bioinformatics. Made by the Casual Collective for games portal Candystand, it runs in-browser and saves your progress as a cookie, and games last a nice 10-15 minutes - perfect for a short break.
The principle of the game is fairly straightforward - you control an asteroid mining company and your job is to extract as much mineral as you can whilst fighting off bands of space pirates. Enemies come in different flavours and you…
revere | February 19, 2009Like a lot of people I am more inclined to believe research that is in accord with my prior beliefs. Put another (Bayesian) way, I don't have to change my beliefs much on the basis of evidence. That means I don't question the evidence rigorously. So with that warning, here's a story I instinctively believe because it accords with my prior beliefs -- and preferences. It has to do with washing your hands after using a public bathroom.
To be clear at the outset: I always wash my hands after using the bathroom. I'm not sure what the actual evidence for disease transmission is but I consider it an…
revere | February 9, 2009I am frankly baffled by a news release from Gideon Informatics, a company that describes its mission as developing and marketing "point-of-care medical-decision support applications that help reduce diagnostic errors." It claims to be "managed by an expert executive team and medical advisory board." Apparently they forgot to give this press release to their advisory board before releasing it:
Despite the recent fatal case of avian flu in Beijing, overall avian flu cases in humans worldwide have decreased 55%, from 88 to 40, from 2007 to 2008, according to GIDEON Online (www.gideononline.com…
tlambert | February 6, 2009Unfortunately, the Journal of Peace Research has published the badly flawed "Main Street Bias" paper. My earlier criticisms still apply, so I'm reposting them. Consider this the first draft of a reply to their paper.
The authors argue that main street bias could reasonably produce a factor of 3 difference.
How did they get such a big number? Well, they made a simple model in which the bias depends on four numbers:
q, how much more deadly the areas near main street that were sampled are than the other areas that allegedly were not sampled. They speculate that this number might be 5 (ie…