Posted tagged ‘public health’

Infection Report 5: What you really should be worried about

October 10, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

This week’s posts have all been about infections, new and old—infections newly found, and infections sneaking back. On the one hand, the media is agog with news of Ebola and the mysterious paralysis virus; on the other hand, threats that are far more likely to kill us are being largely ignored.

One infection is on the verge of sneaking back, which is a shame. We had it beaten, and now we’re allowing it to gain a foothold. We’ve got a great way to eradicate measles, but fear and misinformation have led to pro-disease, anti-vaccine sentiment, especially among those white, elite, and wealthy. As we’ve seen, we’re all in this together—so those anti-vaccine enclaves are going to affect all of us.

Measles, itself, is just about the most contagious disease out there. You don’t need to have infected fluid splashed on you (Ebola), and you don’t need to actually even touch a contaminated surface (influenza). All it takes to catch measles is to breathe the same air as someone with the disease. The measles case doesn’t even still have to be in the same room—particles of infectious measles can float around long after the patient has left. Measles can also be transmitted from contaminated surfaces (and even if person A who touches the surface is immune, he can spread it later on to person B.) Measles is so transmissible that 90% of non-immune people who come near someone with measles will themselves get it. To make matters worse: a person with measles starts spreading virus 4 days before they get sick (compare that to Ebola, which has no transmission until symptoms appear.)

And it’s serious, too. Measles is far more than spots. In the USA, about 1 in 20 people with measles require hospitalization for pneumonia; about 1 in 1000 get brain swelling, which can lead to permanent disability. Measles still kills close to 200,000 people, worldwide, every year (about 1 in 4 people with measles die in the developing world.)

While no vaccine is 100% effective, the measles vaccine is pretty darn close. About 95%-100% of people develop lifelong protective antibodies after the two-dose series. Unfortunately, not everyone can be vaccinated—the vaccine isn’t routinely used less than 12 months, and some people with certain health conditions and immune problems can’t safely be vaccinated. Still, when vaccine uptake rates were strong throughout the developed world in the 1990s, there was very little transmission of measles in the United States, just a handful of cases each year.

And now, it’s back. 2014 is going to have by far the most measles cases in 20 years. Though overall rates of vaccination remain strong, some neighborhoods have immunization rates poorer than third-world countries. And cases that begin or are imported into those areas become outbreaks that public health officials struggle to contain.

Think about this: in west Africa, thousands of people are dying of Ebola, for the lack of rubber gloves and other ways to isolate cases. Here, we do have a safe and effective vaccine against a disease that’s far more transmissible—and some people choose not to get it. There, they battle a lack of basic health resources. Here, our enemy is fear and misinformation. That’s what American families really need to worry about.

This week’s posts about infections new and old were meant to contrast the kinds of challenges faced here, versus the challenges faced in most of the rest of the world. We’re so safe and rich that we can afford to be afraid of things that really shouldn’t scare us (vaccines), while the media becomes preoccupied with things that aren’t likely to become a threat here (Ebola.) We don’t get our flu vaccines because “I heard the flu vaccine can give you the flu” – an utter falsehood that is probably contributing to thousands of deaths. At the same time, we guzzle unnecessary antibiotics for viral infections that do us far more harm than good.

Preventing infections is always the best strategy. Wash your hands, stay away from sick people, keep your kids home when they’re ill, and listen to what every legitimate health authority on the planet says: get yourself and your kids vaccinated. As long as we get them, vaccines are one thing you do not have to worry about.

This week’s posts: The Infection Report

Why are infections such a problem again?

Ebola and you

The single biggest infectious health risk is preventable

Two newcomers and the importance of paying attention

What you really should be worried about

Infection Report 2: Ebola and you

October 7, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Ebola isn’t actually a new infection, but it’s pretty close: the first cases were reported in the 1970’s, in central Africa. Since then there have been several, relatively small outbreaks, typically beginning in communities with close contact with animals, sometimes with infections appearing in chimps or other primates before appearing in people. The infection itself rapidly causes severe disease, and has been associated with a fatality rate in the 50-70% range.

Symptoms begin 2-21 days after exposure, and typically include high fevers, aches and pains, diarrhea, and vomiting. More severe cases develop “hemorrhagic fever,” with bleeding under the skin and in the gut, followed by shock, cardiovascular collapse, and death. This infection is fast, and it is bad news.

But here’s the thing: unlike horrible epidemics portrayed in movies and novels, Ebola is not actually that easy to catch. A person with Ebola cannot spread the virus before symptoms appear—there is no “silent carriage.” You can ride in a planeload of people who have contracted Ebola, but until one of them actually has symptoms, they’re not contagious, and you’re not at risk. And since the symptoms themselves are not subtle, it is unlikely that someone with Ebola is quietly sitting next to you on a bus. Those people are going to head to the hospital, pronto.

And, even if that person is sitting next to you on the bus is sick with Ebola, you cannot catch Ebola unless you come in direct contact with body fluids: blood, bloody diarrhea, or vomit. Staying away from blood, bloody diarrhea, and vomit is a good idea, whether or not there’s any Ebola around.

Though there’s media panic brewing, containing Ebola in the United States is something we’re equipped to do. We’ve got a good public health infrastructure in place, and we’ve got hospitals equipped to handle infectious material from sick people. What we need to do most, here, is to stay aware of the possibility of Ebola in people who’ve recently been in west Africa, where Ebola cases have truly become epidemic (mostly Sierra Leone, Liberia, and Guinea.) If people who’ve lived or traveled to those areas become ill with fevers and other Ebola symptoms, they need to be treated, isolated, and tracked.

The problem, honestly, isn’t here. The problem is in west Africa, where there is no public health infrastructure, and no hospitals, and no way to protect families and communities from contact with Ebola. When someone gets sick, they stay home with their families, and they are spreading infectious fluids. It’s nearly impossible to clean up those homes or protect people. No gloves, no disposable sheets, no autoclaves, not even enough plastic body bags. It is truly a health disaster, and we need world governments to step up to help the people there—or this is going to spread throughout the developing world. And, of course, the more cases there, the more the risk here, as it becomes more difficult to identify people exposed to cases that might spread to an ever-widening area. Helping the people of west Africa overcome this epidemic is both a moral and public health imperative.

Unlike Ebola, which can’t spread in the air and is only being contracted by people in a limited area, there are far-more-common infections right here, right now, and one of those will end up sickening far more of us in the United States. Yet many of us won’t even bother to take one simple, safe step to prevent it. Want to do something that can really help keep your family safe this winter? Tune in tomorrow!

More about Ebola from the CDC, and my Ebola podcast from The Great Courses.

Next: an infection that kills thousands in the USA… and can be prevented.

Infection Report 1: Why are infections such a problem again?

October 6, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Once again, infections are in the headlines.

Ironically, it wasn’t that long ago, around the 1950’s, that many people thought we had infections beat. Antibiotics could cure any infection, and the pace of new drug development was exploding. We were sure to outwit the stupid microbes. We’ve learned a lot since then:

1. Evolution by natural selection works. When the environment puts pressure on living things, the population best equipped to thrive under those conditions expands. In other words, the use of antibiotics encourages bacteria to become resistant. This is especially true when antibiotics are used indiscriminately, incorrectly, and inappropriately. And antibiotics can cause other side effects, too. In the long run, if our only weapon against infection is antibiotics, we are going to lose.

2. New viruses are guaranteed to appear, and are guaranteed to spread. The last 50 years has seen the rise of AIDS, SARS, MERS, and Ebola. There is no way to prevent the appearance of new viral infections.

3. The success of public health efforts to contain disease undermines public confidence in the need for public health efforts. I know, that sounds weird. But once disease XX becomes rare (typically through a whole lot of public health effort), people stop worrying about it. They even sometimes begin to distrust the system and the people whose work stopped the disease in the first place. Once strategies to contain disease are offhandedly dismissed, the diseases come back.

4. The world is big, and the world is interconnected. Diseases no longer lurk only in secluded areas or remote villages. Conditions in resource-poor parts of the world contribute to the development of new infections: living closely with animals, poor sanitation, lack of health education and resources, and ineffective government or public support for health maintenance and surveillance. Once new infections appear, they’re bound to spread—people routinely travel by planes across entire continents.

Sound grim? Maybe. Threats certainly loom, and they’re much closer than the horizon. What should you be doing to protect yourself and your family? This week’s daily posts will be about infections new and old, the ones in the news and the ones most likely to make your family sick. You might be surprised to learn that what you are worrying about and what you should be worrying about aren’t the same things, and that there are simple and safe things that you really should be doing to protect your family from real threats. The media is seething with news and worry—but I think, for the most part, they’re missing the point.

Next: Ebola and you

The perils of banning plastic grocery bags

March 11, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

I’m one of us who tries to remember to use those cloth, reusable bags at the grocery. Really. There’s a bunch of them, sitting in the trunk of my car, just ready to be filled and re-filled with groceries. They usually just sit there, forgotten.

Apparently, they’re more active than I realized. They’re busy growing a whole host of nasty germs.

As reported in detail by Ramesh Ponnuru at, there may be an unexpected downside to using those cloth bags. Researchers have found that they’re often filled with bacteria from human and animal stool that can make you sick. Apparently, these sorts of bacteria can be transferred from fresh veggies and other food onto the bags, and they multiply like crazy in your warm trunk.

Mmmm. Colon bacteria.

It’s not just theoretical, either—some evidence has shown that those bags really could make you sick. Local ER visits for E coli infections, caused by one of those tasty stool bacteria, increased immediately after San Francisco’s plastic bag ban, as did salmonella-related illnesses.

There is some good news: the same researchers who documented that these bacteria were  common also found that ordinary washing could dramatically decrease bacterial colonization. Too bad only 3% of the families surveyed bothered to ever wash their bags. I know I don’t.

So: could the net effect of the discouragement or banning of plastic grocery bags be detrimental to our health? I would say the jury’s out. Too many variables to be sure. But clearly, as usual, there may be unintended consequences of legislation to ban these bags. We may end up sicker. Or, we might have to wash our cloth bags—which uses more water and electricity, offsetting the environmental advantage of reusable bags. This whole situation might encourage the use of more paper, recyclable bags, but they have their own, different environmental impact on trees and water and energy use.

I don’t think there’s a simple, best answer here. It makes sense to reduce the use of resources, to re-use plastic or paper or cloth bags when practical, and to recycle things that can be recycled. Beyond that, are cloth bags definitely, always better than plastic? Maybe not.