Without Syndromic Surveillance Systems, some things can get really hard to see

So the slow reaction of Germany and other European countries has been bad, in the case of a known but unusual infection. How bad would it be in case of an unknown novel pathogen? A lot worse, I would guess.  It is a shame that this article, in Nature, blames everything EXCEPT the lack of a syndromic surveillance system:

Microbe Outbreak Panics Europe
Spread of rare strain raises questions over surveillance of infectious diseases.

By Marian Turner of Nature magazine

Munich

Confronted with what has become one of the world’s most severe outbreaks of Escherichia coli, physicians and scientists in Germany say that the country’s fractured health-management system has failed to handle the crisis properly. They are calling for major reforms so that outbreaks are reported sooner and more modern technology is used to help identify their source, in order to bring health emergencies under control more quickly.

..

Hospitals recorded the first cases on 1 May, according to the Robert Koch Institute (RKI), the German federal agency for disease surveillance in Berlin. Yet it was not until 22 May that the first report of an unusual number of EHEC infections in Germany arrived at the European Centre for Disease Prevention and Control in Stockholm. This was unusually long–it typically takes 14 days to detect an outbreak, says Angelika Fruth from the RKI.

Several factors conspired to cause the delay. EHEC infections are not common in adults–so physicians might have initially diagnosed a Salmonella or viral infection. The microbe also behaves differently to typical EHEC strains when cultured for diagnosis, which hampered scientists trying to identify it. And under the German health system, local authorities only report such infections weekly to state governments–which then have another week to tell the RKI. It was not until 25 May that the rare E. coli strain O104:H4 was named as the culprit.

Continue reading “Without Syndromic Surveillance Systems, some things can get really hard to see”

Without Syndromic Surveillance Systems, some things can get really hard to see

Crowd Sourced Health information

Very similar to the site “Who is Sick?” which I’d covered previously, the site “Bed Bug Registry” contains crowd-sourced information on which hotels have bed bugs.  Question: How to maintain the integrity of this information, when competitors could very easily place false reports of others’ hotels having bed bugs?  In any case here’s the link: http://bedbugregistry.com/

Crowd Sourced Health information

Without chemistry, Life itself would be impossible…(Part II)

I really hated that old commercial, which was being widely played in the early to mid 80’s, so this post is a follow-up to that irritating, then-ubiquitous ad.  SNL did a great spoof of this; its probably on youtube now.  Well the chickens have come home to roost.  But where are the folks at that PR firm that thought up that original ad, taking care of their autistic grandchildren? Probably not–they are hiring that out to their live-in nannies, which they can surely afford:

New Study: Autism Linked to Environment

Research links soaring incidence of the mysterious neurological disorder to fetal and infant exposure to pesticides, viruses, household chemicals
By Marla Cone

California’s sevenfold increase in autism cannot be explained by changes in doctors’ diagnoses and most likely is due to environmental exposures, University of California scientists reported Thursday. The scientists who authored the new study advocate a nationwide shift in autism research to focus on potential factors in the environment that babies and fetuses are exposed to, including pesticides, viruses and chemicals in household products.
“It’s time to start looking for the environmental culprits responsible for the remarkable increase in the rate of autism in California,” said Irva Hertz-Picciotto, an epidemiology professor at University of California, Davis who led the study.

Further thoughts on developments such as this, obviously the first of many:

Continue reading “Without chemistry, Life itself would be impossible…(Part II)”

Without chemistry, Life itself would be impossible…(Part II)

The material is of a type that is often made public, however we have so far been unable to find reference to the report on cdc.gov or elsewhere on the internet or in the press.

A leaked Powerpoint presentation from wikileaks, showing that wikileaks is doing exactly what it should be doing: providing the raw information for good public health reporting, public health reporting that causes those in power to be asked a lot of difficult questions, so that things get fixed.  In this case the information is the dramatic rise in human rabies cases in China from 1996 (159 cases) to 2007 (3,300 cases).  It is sad to see China backslide, going so far backwards.  That’s why now, more than ever, China needs democracy.

The title of this post is the note the uploader of the leaked document added when she/he uploaded the file to wikileaks.

But, question, where is the public health reporting on this issue?  I understand it won’t happen in China, with their rather constrained press, but why not in Taiwan or Singapore?

rabies_explosion_china_chart1

rabies_explosion_china_map_19995

rabies_explosion_china_map_20073

The material is of a type that is often made public, however we have so far been unable to find reference to the report on cdc.gov or elsewhere on the internet or in the press.

A New Animal Pathogen?

A potential outbreak with certain parallels to prion diseases, but other differences as well. Similar in that that those affected worked in the department that rendered pork brains, and their initial symptoms seem to be neurological. However, having 12 cases in less than a year suggests something faster spreading, perhaps a virus, or also a neurotoxin is still something to look into. There’s not a lot of information in the initial reports. So go to work public health reporters!

Recall that the first cases of SARS have also been traced to animal renderers, although that was in China, so this item didn’t appear in newspapers until several months after the outbreak started. And there’s some health issues in China that are not being subjected to very much scrutiny, like this outbreak of strange neurological symptoms and this outbreak among swine. As the Chinese leadership apparently mis-learned the lesson from SARS, which for them unfortunately was: do a better job of covering up disease outbreaks.  Highly recommended here is Karl Taro Greenfeld’s book The China Syndrome.

If there is one point of the posts on this site regarding Public Health it is this: the quality of public health reporting will infinitely affect your lives, much more than 99.9% of the other stuff carried in most newspapers today.  And the scope of that high quality public health reporting, due to our highly globalised flows of people and food, has to be international, not just local. 

But the US still has a relatively free press, recent developments not withstanding, so we still get a disease monitoring system for free, and here it is at work:

Continue reading “A New Animal Pathogen?”

A New Animal Pathogen?

Writing between the lines

A great piece of public health reporting, which I have come across in the book The China Syndrome by Karl Taro Greenfeld. I rather like the book which is a good starter for anyone interested in the intersection of public policy/human rights, the public health infrastructure, and epidemiology. It could, however, have a different title, as the lessons can be generalized outside of China. And there was another book or movie by that name, about some lose Chinese nukes or some such nonsense.

At the intersection of science, freedom of the press and political power a lot of very interesting things happen, and it is enlightening to see how people resolve their competing allegiances. A similar dynamic is now playing out in the reporting of global warming, with some saying, basically “Global Warming is only a rumor,” and others showing some evidence, which is being largely ignored by Bush & Co. (Another example of Convergence?)

The book is about the SARS epidemic, with a special focus on how it got started and and personalities involved. In this case, a reporter in China who is aware his work will be censored, still manages to get out all the essential information. This is one of the very first stories about what would later be named SARS (Sudden Acute Respiratory Syndrome) and the reporter does an excellent job, being caught between the reality of government censors and his responsibility to provide information about a matter of overwhelming public iimportance:

From the Heyuan Daily:

Continue reading “Writing between the lines”

Writing between the lines

Yes, they should…

Coverage by the Boston Globe of an ALS (Lou Gehrig’s disease) cluster in Southeastern MA. Not regular news coverage, but this is an OP-Ed, about Public Health (!):

Disease cluster mystery

FOR MORE than 20 years, health officials have known about a puzzling concentration of the neurodegenerative illness known as Lou Gehrig’s disease in the southeastern Massachusetts town of Middleborough. In the coming months, a study financed by the federal government and conducted by state environmental health scientists might answer the riddle of whether toxic waste from two Superfund sites in the town has caused the rare and usually fatal disease, which normally strikes just two of 100,000 people.

It would have been nice had the author seen fit to disclose the rate in the Middleborough area, and talk a bit about the odds of that cluster being a random occurrence. Let’s give the public some numbers, not everyone is innumerate.

But here’s where this OP ed really falls down, IMHO:

Continue reading “Yes, they should…”

Yes, they should…