Tuesday, January 16, 2018

Not all the epidemics came from Europe

While checking out the history of diseases that cut the population of the Americas after the Europeans arrived, I ran into the story of an epidemic that was not known to the Spaniards but was known to the Indian curers, and that killed in a different pattern than the European introduced smallpox/influenza/measles epidemics.

HERE is the CDC article discussing the disease.

Recent epidemiologic research suggests that the events in 1545 and 1576, associated with a high death rate and referred to as cocoliztli (Nahuatl for "pest"), may have been due to indigenous hemorrhagic fevers (4,5)... 
Many of the symptoms described by Dr. Hernandez occur to a degree in infections by rodent-borne South American arenaviruses, but no arenavirus has been positively identified in Mexico. Hantavirus is a less likely candidate for cocoliztli because epidemics of severe hantavirus hemorrhagic fevers with high death rates are unknown in the New World. The hypothesized viral agent responsible for cocoloztli remains to be identified, but several new arenaviruses and hantaviruses have recently been isolated from the Americas and perhaps more remain to be discovered (11)
they suspected it was spread by a rodent, similar to hanta virus or the plague.

as for the remarks that maybe the Indians knew about small pox before the Europeans arrived, one wonders if they were describing chicken pox (or even secondary syphilis aka the great pox) which has a similar rash.



Discovery magazine has a less technical article.


Then, four centuries later, Acuña-Soto improbably decided to reopen the investigation. Some key pieces of information—details that had been sitting, ignored, in the archives—just didn't add up. His studies of ancient documents revealed that the Aztecs were familiar with smallpox, perhaps even before Cortés arrived. They called it zahuatl.
Spanish colonists wrote at the time that outbreaks of zahuatl occurred in 1520 and 1531 and, typical of smallpox, lasted about a year. As many as 8 million people died from those outbreaks.
But the epidemic that appeared in 1545, followed by another in 1576, seemed to be another disease altogether. The Aztecs called those outbreaks by a separate name, cocolitzli.
For them, cocolitzli was something completely different and far more virulent," Acuña-Soto says. "Cocolitzli brought incomparable devastation that passed readily from one region to the next and killed quickly." 
After 12 years of research, Acuña-Soto has come to agree with the Aztecs: The cocolitzli plagues of the mid-16th century probably had nothing to do with smallpox. In fact, they probably had little to do with the Spanish invasion.
so today the Atlantic magazine has an article discussing this dreaded disease. DNA studies on teeth show evidence of paratyphoid.


Now, DNA from 16th-century cocolitzli victims has offered up a somewhat unexpected new candidate: Salmonella enterica, or the bacteria that cause paratyphoid fever. The DNA evidence comes from the teeth of 11 people buried in a large Mixtec cemetery in southern Mexico. Prior archaeological work had linked the burials to the 1545 cocolitzli epidemic, and the city was likely abandoned after the disease killed so many of its inhabitants.,..
Acuña-Soto still favors his viral hemorrhagic-fever hypothesis, and he notes that Salmonella has never caused another epidemic as deadly as cocoliztli in recorded history. The strain most similar to the one found in the 16th-century teeth is rare and not well-studied, but it has a 10 to 15 percent mortality rate today. It is also not entirely known whether Salmonella was present in the Americas before contact with the Spanish or how pervasive it was in Europe..
that was my impression also, that paratyphoid was not that virulent.

But diseases do change with time.

for example the Athenian plague victims  tested positive for regular typhoid, but many dispute that too.

but when you read about how San Diego is being threatened by Hepatitis epidemic because the homeless spread feces on the street, just remember: Typhoid, paratyphoid, cholera and shigellosis, not to mention viral diarrheas, are also spread that way.

update: Long article in Nature discusses the disease but alas is behind a paywall if you want to read the whole thing.

Monday, January 15, 2018

Return of Diphtheria

The BBC reports that there had been an outbreak of diphtheria among the Rohingye refugees in local refugee camps.

Reuters report adds: first there was cholera, now Diphtheria.


Unclean water, crowded shelters and dirty conditions create a perfect environment at the Balukhali refugee camp for spread of preventable diseases. The camp is in Cox’s Bazaar, a town in southeastern Bangladesh. It is home to some of the estimated 650,000 Rohingya Muslims who fled unrest in neighboring Myanmar.
More than 200 mobile vaccination teams have given about 900,000 doses of oral cholera vaccine to the refugees.
However, another contagious bacterial infection, diphtheria, has appeared.


the full report from the UN is here:


UN estimates show that some 655,000 people have fled Myanmar to Bangladesh since August 2017. Diphtheria is an infectious disease caused by a bacterium which primarily infects the throat and upper airways, and produces a toxin affecting other organs. The diphtheria toxin causes a membrane of dead tissue to build up over the throat and tonsils, making breathing and swallowing difficult. The disease is spread through direct physical contact or from breathing in the aerosolized secretions from coughs or sneezes of infected individuals. Between 8 November 2017 and 11 January 2018, as many as 31 deaths and 3,954 suspected cases of diphtheria have been reported from Cox's Bazar. Nearly 10,594 contacts of these suspected cases have been put on diphtheria preventive medication.

they are also giving shots to the kids in the nearby villages.

To limit the spread of diphtheria to communities living near the Rohingya camps and settlements, nearly 160,000 children in 499 schools of Teknaf and Ukhiya sub-districts are also being vaccinated.
National Geographic article here.


this is ethnic cleansing of a group that moved to Burma a hundred years ago but never assimilated and were never considered full citizens. They are Muslim whereas most Burmans are Buddhists.

They have been treated poorly by the locals, to say the least, but this last crisis, which is true ethnic cleansing, was precipitated by some of the earlier refugees becoming terrorists, causing a backlash against the entire population.

Sigh.

Wikipedia article on the Rohingye.

this article suggests the vaccination rate for DPT has actually decreased over the last 7 years from 90 percent to 75 percent coverage.

this article discusses the logistical and social problems of vaccinating the children of Burmese refugees in the Tak area of Thailand, but does not mention the ethnicity of these refugees.

But the Wikipedia article on Tak Province mentions they are Karen refugees.

According to the UNHCR data of 2008, nearly 95,000 of Thailand's 121,000 registered refugees from Burma are housed in several refugee camps in Tak province of which Mae La camp is the largest with around 45,000 Karen refugees.[14]
the Wikipedia article on the Karen people.

 The Karen make up approximately 7 percent of the total Burmese population with approximately 5 million people.[6] A large number of Karen have migrated to Thailand, having settled mostly on the Thailand–Myanmar border....
Around 400,000 Karen people are without housing, and 128,000 are living in camps on the Thailand-Burma border. According to BMC, "79% of refugees living in these camps are Karen ethnicity."[31] Their lives are restricted in the camps because they usually cannot go out, and the Thai police might arrest them if they do
more information on the tribal refugees here.

Fox news article on the resettlement of these refugees in Iowa.

Burma is made up of hundreds of distinct ethnic groups, with one, the primarily Buddhist Bamar, dominating Burmese society and politics. The largest Burmese ethnic groups in the U.S. include the Chin, who live in the west and are persecuted for their Christian beliefs, and the Karen, who are fighting against ethnic cleansing and Burmese military abuses, according to the Ethnic Minorities of Burma Advocacy and Resource Center (EMBARC)  in Des Moines.



Friday, January 5, 2018

Generic drugs and the Clinton foundation

Like a lot of "charitable Trusts" (or like the Vatican for that matter), the Clinton foundation is probably doing good while supporting a lot of hucksters.

Charles Ortel writes about that here. I don't understand much of it, being an economic/financial illiterate, but this part I do know something about:


How did Deputy Attorney General Rod Rosenstein, while U.S. attorney in Maryland, miss the fact that the Clinton Foundation was promoting use of potentially adulterated HIV/AIDS drugs from October 2003 forward, even as he took until May 2013 to help win a $500 million set of penalties against the Indian manufacturer of the generic drugs?

there has been a big push to let people use "generics", but the dirty little secret is that a lot of Chinese and Indian companies don't have the quality control standards of western companies, and what is worse, a lot of them adulterate the medicine or even push counterfeit medicine that doesn't work as the real thing.

To make things worse, they underprice western companies, meaning that now even brand name drugs might be made overseas: The heparin scandal, where a cheaper chemical was added to the heparin so that it could pass the testing phase but didn't work and killed a few people is the tip of the iceburg.

Fake antibiotics and anti malarials are the cause of many deaths in poor countries, as the linked article goes into the many ways and problems with generics. And since people often die despite the best treatment, one can see how deaths can be overlooked or hidden, especially in rural areas or the slums of poor countries.



and then you have the "cough medicine" deaths because they added antifreeze as a cheap sweetener to cough medicine, and killed at least 100 people in Central America. 

after "activists" condemned "big pharma" for opposing the use of generic medicines for HIV, Bill Clinton's push to get the generics was hailed... but not really examined closely.



Friday, December 29, 2017

MARIJUANA IN PREGNANCY

fetal alcohol syndrome is a terrible problem, but now we see marijuana use in early pregnancy soaring, and it is worse because some women seem to be using it as a "treatment" for morning sickness in the first trimester, when fetal development is most sensitive to chemicals.

CDC report here.


It is important to include accurate information about the health risks of using marijuana for a mother and her baby. Some important ideas to convey include, marijuana use during pregnancy may increase your baby’s risk of developmental problems; the chemicals in any form of marijuana may be bad for your baby (this includes edible marijuana products such as cookies, brownies, or candies);
marijuana use during pregnancy may negatively impact your baby after birth (research shows marijuana use during pregnancy may make it hard for your child to pay attention, learn, or do well in school and these issues may only become noticeable as your child grows older); and if you’re using marijuana and are pregnant or planning to become pregnant, talk to your doctor.

Wednesday, December 27, 2017

Good news of the year: Measles deaths are decreasing dramatically

NYTimes:

For the first time in history, annual deaths around the globe from measles have fallen below 100,000, the World Health Organization announced this year. As recently as the 1980s, measles killed 2.6 million people a year.

it is a killer of malnourished children. Some cynics suggested that since measles only killed malnourished kids, whose IQ from malnutrition was low anyway, we should not bother to vaccinate the kids in rural Africa, since they would probably die of something else or end up as low IQ workers.

This was 40 years ago, and gives you an idea of how apartheid's Nazi links morphed into other nearby countries.

Indeed, many of our malnourished kwashiorkor (protein malnourished children) died of measles. Our solution was to encourage spacing of children, to improve the length of breast feeding, measles shots, protein supplements, and have our village health workers weigh children and refer them to our nutrition village to feed up and show moms cheap high protein food (e.g. hybrid chickens who both had the disease resistance of local chickens and the high egg volume of imported varieties. We also taught how to keep them in cages, so the eggs would not be lost).

But even in the US, I saw measles encephalitis.

the problem with history: The Plague

CDC article for later reading: dangers of non critical reading of historical plague data.

 Plague outbreaks in Europe, 1347–1760. Map produced on the basis of data from Biraben (2,3). Map provided courtesy of Yue et al. Navigable rivers facilitated the spread and recurrence of plague in pre-industrial Europe. Sci Rep. 2016;6:34867 (6).
technical and mainly bookmarked for later reading.