Wednesday, April 16, 2014
Inquirer Daily News

Infectious disease

POSTED: Wednesday, April 2, 2014, 6:30 AM
The Plague marched across Europe in the mid-1300s; death followed quickly.

On television, forensic scientists can solve the mystery of someone’s death in an hour. In reality, uncovering the facts can take a lot longer. As an anthropologist leading the investigation of some skeletons dug up in England last year put it: their discovery “solves a 660-year-old mystery.” DNA tests on the skeletons revealed that they didn’t die of bubonic plague; they died of pneumonic plague.

Workers extending the London railway line unearthed 25 skeletons. They were victims of the Black Death that ravaged the world from 1348 to 1350, killing at least 75 million people. Scientists examining the bones confirmed not just the cause of death but details about the lives of those who died. Their bones reveal lives marred by violence and characterized by heavy work and malnutrition. The Black Death carried them away quickly. Untreated, it can kill in a few days. With no understanding of the cause of the disease, 14th-century Europeans often blamed Jews and foreigners for the disastrous epidemic that transformed life around the globe.

Bubonic plague is spread by fleas from infected rodents and is now easily cured by antibiotics. If the infection reaches the lungs and becomes pneumonic plague, however, it can be transmitted from person to person via infected droplets in cough. Victims must be treated promptly; mortality rates from this form of the disease are high. There is a third form of plague, septicemic plague, also spread by fleas.

POSTED: Thursday, January 30, 2014, 6:30 AM
During World War I, the U.S. military tried moralizing, like with this 1918 Army poster. The next war brought condoms.

Thanks to Fox News host and former Arkansas Gov. Mike Huckabee, we get to revisit the public health lessons of the First and Second World Wars.

In a recent address to the Republican National Committee, Huckabee excoriated Democrats for making women believe they were “helpless without Uncle Sugar coming in and providing…birth control because they cannot control their libido…”

Ironically, if we were to change a few words in that remark—“Uncle Sugar” to “Uncle Sam,” and “female” to “male”—we’d find ourselves transported back to 1942.

POSTED: Tuesday, December 10, 2013, 6:30 AM

If you are looking for two great public health movies to snuggle up with your family on the couch or to buy for your woefully public-health-history-ignorant friends this holiday season I have two recommendations: Dr. Ehrlich’s Magic Bullet, a Hollywood biopic made in 1940 starring Edward G. Robinson, and How To Survive A Plague, a 2012 documentary.

These Oscar-nominated films (the first for best screenplay, the second for feature documentary) deal with the battle against what were once called venereal diseases and are today referred to as sexually transmitted infections (STIs) or diseases (STDs). They deliver a similar message: ignorance can be the greatest enemy of public health. That’s a message we can all embrace this holiday season, right?!?

In Dr. Ehrlich’s Magic Bullet, the valiant German Jewish scientist Paul Ehrlich confronts repeated failures and professional skepticism to develop the first cure for syphilis in 1909 -- arsphenamine (Salvarsan). While the movie doesn’t do full justice to the real Dr. Ehrlich’s many brilliant scientific contributions, for which he won a Nobel prize in 1908, the film’s release was in itself a triumph over ignorance. In bringing the subject of syphilis to the screen, Warner Brothers took a bold step. Venereal disease was a subject thought unfit for polite discussion, much less for mass media. The producers managed to get around the Motion Picture Production Code (Hays Code), which stated that “Sex hygiene and venereal disease are not subjects for motion pictures” by rarely using the term syphilis and focusing the film on scientific discovery and on Ehrlich as scientist. Despite their boldness in mentioning a venereal disease, the film’s producers shied away from mentioning Ehrlich’s religious background, even as the United States was engaged in fighting a Nazi regime that purged all mentions of Ehrlich’s work because he was Jewish.  

POSTED: Tuesday, December 3, 2013, 6:30 AM

With Sunday's World AIDS Day, behind us, today is as good a day as any to think about the future and to embrace the World Bank’s “Development Goal 6”: “to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment and mitigation services for those affected by HIV and AIDS.“

Here in the United States, the Centers for Disease Control and Prevention (CDC) website Act Against AIDS has fact sheets and testing information available, as well as a reminder that over one million people in the United States are living with HIV.  While there is no cure for HIV/AIDS there are drugs available to control the virus, and President Obama on Monday announced the $100 million funding of a new National Institutes of Health initiative to discover next-generation therapies. That’s the good news. The bad news is from the Morbidity and Mortality Weekly Report, the weekly epidemiological digest published by the CDC. It finds that rates of unprotected sex by men having sex with men have increased between 2005 and 2011. 

There’s a public health solution for that: harm reduction, a strategy that seeks to reduce the harm from a hard-to-stop behavior, most typically drug use, rather than stopping the behavior itself. reduction.  The CDC report makes clear the steps that are needed: “Health-care providers and public health officials should work to ensure that 1) sexually active, HIV-negative MSM (men having sex with men) are tested for HIV at least annually (providers may recommend more frequent testing, for example every 3–6 months); 2) HIV-negative MSM who engage in unprotected sex receive risk-reduction interventions; and 3) HIV-positive MSM receive HIV care, treatment, and prevention services.”

POSTED: Wednesday, November 6, 2013, 10:16 AM
Polio vaccine is given as part of a UNICEF-supported program in Damascus. With 10 cases in Syria, nations nearby are ramping up their own vaccinations. (OMAR SANADIKI / UNICEF)

The outbreak of polio in the Syrian Arab Republic announced by the World Health Organization a few weeks ago is a troubling reminder that global conflicts threaten the public’s health. Violence, like the 2-1/2-year-old civil war in Syria, can lead to significant disruption and/or long term damage to the public health infrastructure, including basic sanitation efforts, maintenance of a safe water supply, basic nutritional needs, and disease monitoring and prevention.

Because of the Global Polio Eradication Initiative, this latest outbreak is especially troubling. But it should not be surprising. The displacement of so many Syrians fleeing the fighting has devastated the county’s once robust public health infrastructure and stymied immunization efforts. Syria had been polio-free for a decade. Ten polio cases, with many more likely to be reported, are now confirmed.

Polio, technically known as poliomyelitis, is a viral disease that can lead to full or partial paralysis, and sometimes death. The United States experienced periodic local polio epidemics until the development of the Salk and Sabin vaccines, introduced in 1955 and 1963 respectively. Before the vaccines were introduced, tens of thousands of Americans contracted the virus, which could leave them either partially or completely paralyzed. Dr. Jonah Salk’s birthday, Oct. 24, is now celebrated as World Polio Day.

POSTED: Friday, November 1, 2013, 6:30 AM
Maybe it was TOO spicy for this guy. (AP/PETA)

Just when you thought our food supply was safe again.

In the wake of the government shutdown that suspended many of the essential protective services of the Food and Drug Administration and the U.S. Department of Agriculture (we wrote about this a few weeks back), an  FDA report – released, appropriately, on Mischief Night – finds that the spices we season our foods with can be tainted with pathogens and filth.

A spicy meal, anyone?

POSTED: Monday, October 28, 2013, 6:30 AM
Filed Under: Food | Infectious disease

With a squeeze of lemon and a dash of hot sauce, raw oysters are a winter delicacy. Unfortunately, a recent letter  in the New England Journal of Medicine warns, strains of Vibrio parahaemolyticus are contaminating some of them harvested from parts of the Atlantic Ocean.

What is Vibrio parahaemolyticus?

Vibrio is a group of bacteria that cause a variety of digestive issues. Other types of Vibrio cause severe illnesses such as cholera or blood infection. The bacteria noted in the letter, Vibrio parahaemolyticus, causes comparatively milder symptoms: diarrhea, vomiting, abdominal cramping, nausea, fever, and chills. Oysters and other shellfish become contaminated because V. parahaemolyticus naturally occurs in the waters where they live. These shellfish are the usual cause of the illness. Vibriosis can be especially dangerous for people with weakened immune systems but is rarely fatal for healthy people. The symptoms usually go away on their own within three days. (People taking antacids are more susceptible because stomach acid can help destroy bacteria, and antacids weaken the stomach acid.) The Centers for Disease Control and Prevention estimates there are around 4,500 cases of vibriosis caused by the species parahaemolyticus each year.

POSTED: Thursday, October 17, 2013, 11:50 PM

“Against the assault of laughter,” Mark Twain once wrote, “nothing can stand.” Not even a bad divorce is safe from that assault, as you’ll quickly learn if you go see the new film A.C.O.D. (Adult Children of Divorce), opening this weekend in Philadelphia.

As your resident public health expert I could tell you that you should head to the Ritz at the Bourse because laughter is the best medicine. After all, laughter has been shown to relieve stress and pain, improve your mood, and even induce changes in your immune system. I could also tell you that if you are looking for new ways to burn calories, look no further than a good, sustained, hearty laugh—one study suggests 10-15 minutes of laughter a day might be all you need.

I could go on with the public health explanations of why you should see this insightful, funny, and bittersweet film about how adult children cope (or don’t) with their parents’ divorce. But let’s turn instead to A.C.O.D.'s director, Stu Zicherman (full disclosure, Stu is an old friend), who offers up advice about suffering from and laughing at being an A.C.O.D.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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