Polio update

Doctors are hoping to eradicate polio the way they eliminated smallpox.

CDC report on the program.
CDC notes the support services for the locals are the unsung heroes.

 With more than 300 personnel at national, state, and local government area levels supporting the program’s projects across the states and local government areas, the National Stop Transmission of Polio (NSTOP) programs train health care professionals, native to and living in their respective countries, in polio eradication and field epidemiology. Modeled after the CDC-World Health Organization (WHO) STOP program, the programs receive financial support from the CDC and other international agencies, while receiving technical assistance from CDC’s Global Immunization Division and Field Epidemiology and Laboratory Training Programs (FELTPs).

their reports are quite technical. But for a holistic report on the problem:
StrategyPage has this snip about the problems of doing this in war torn areas.

In northwest Pakistan police arrested five members of the Pakistani Taliban as a result of tips from local residents. Under questioning one of the five admitted who they were and what they were up to..... The five were planning attacks on the polio vaccination effort and any other government operation they could get to.

Vaccination teams are particularly vulnerable because they must visit the most remote and lawless areas to deliver the vaccination to vulnerable children. Parents tend to favor the vaccination and given the proliferation of cell phone service it is rather easy to call in or text a tip about some threat to the vaccination effort.

The Afghan Taliban appear to have realized this but some of their Pakistani counterparts have not or just don’t care. Because of this the Pakistani Taliban have become the major obstacle to finally wiping out polio.

In the last decade the main obstacle has been Islamic terror groups who ban polio vaccinations and attack anyone trying to deliver the vaccine to vulnerable children. Islamic terrorists in general tend to believe the vaccination teams are spying for the government and that the vaccinations are a plot to sterilize Moslems.

In Pakistan and Afghanistan there are still religious problems with vaccination. The Afghan Taliban now openly support the vaccination program but there still some rural areas where local Moslem clerics or teachers continue to denounce the vaccinations. There is a similar situation in Pakistan, where some fringe Islamic groups still try and kill members of the vaccination teams.

Despite the death threats there is another major effort this year to vaccinate vulnerable Afghan and Pakistani children against polio. In 2016 there were 20 cases of polio in Pakistan and 13 in Afghanistan. There were four in Nigeria, a country that is expected to be free of polio this year or next. Despite this continued resistance polio cases in Afghanistan and Pakistan continues to decline. For Afghanistan there have been at least six cases so far in 2017 compared to 13 for 2016. In Pakistan the situation is similar with about the same number of cases in 2017. Nevertheless the global vaccination effort has worked. In the 1980s, when the polio elimination effort began there were 350,000 cases in 125 countries.

For the last several years there have been fewer than a hundred cases worldwide. After a few years of no reported cases polio will gone, as happened with smallpox in the 1970s.

Hepatitis: now in LaLaLand

Yes, the lovely city of Los Angeles now has a problem with hepatitis.

 Back In 2012, the Los Angeles Community Action Network predicted that Skid Row was ripe for disease in a report similar to the one earlier this year. Then, just as now, restrooms often lacked soap, water, toilet paper and trash cans.
“The City of Los Angeles has failed miserably when it comes to providing accessible and clean public restrooms, thereby creating and maintaining the human rights violations cited in this report and others,” the report said. “It is an obvious fact that human beings simply must relieve themselves regularly. All residents face the need for public restrooms, it’s just that homeless residents are entirely reliant on public options.”

Maybe they should hire Claire Frazer to tell them how to fight the epidemic




basic hygiene:

Toilets

and hand washing

SARS and Plague and Birdflu

NYtimes reports over a thousand cases of birdflu  in China, with some cases suspected of being spread person to person.

and there is some evidence it is evolving, plus evidence it has spread to ferrets.

and I''m old enough to remember how China covered up the SARS epidemic, so this might be worse than reported.

Ironically, the SARS epidemic was stopped the old fashioned way: Quarantine and isolation of patients. 

Everyone in airports were checked for fever before boarding, and stopped from flying, and local cases were isolated in hospitals.

but why worry about bird flu when the black death is becoming epidemic in Africa? This is especially dangerous because it is the pulmonary  variation, which is airborne and doesn't require fleas.

GEtting high on Tramadol

There is a bit of a kerfuffle on the BBC because a british lady was arrested for smuggling Tramadol to her young husband who claimed he needed them for his back pain.

She was carrying 300 tablets, so the number is borderline if personal use or for sale.

Tramadol in the US is a mild narcotic pain killer we give instead of the more addicting Percocet or Tylenol 3 to old folks in pain.

But in the Middle East, it is a major problem for abuse, including having the terrorists take it to get high before they go out to fight.

UKMirror article.

an interpol article says the source of the drug in the Middle East comes from "Asia". Well, duh.

this article in the Indian press suggests one of their companies was behind the huge amount seized in Italy.
DNAIndia also notes that they are the source of illegal Tramadol used by terrorists and others in the Mediterranean.



Conversation.com has a long article on the uses of this mild narcotic, but then goes on to discuss it's abuse in Africa and the Middle East.

 tramadol is popular in Egypt and is misused widely. Indeed, besides it being a recreational drug, many people – especially from the poor working class – take tramadol to give them more energy, to work for longer or to hold down two jobs.
It has been a particularly serious problem in places such as Gaza, where addiction has led to an illegal trade in tramadol, often smuggled in through underground tunnels. This has led the government to take a particularly hard line on it.

but use and abuse are two different things: The dosage differs.

The usual dosage of Tramadol for pain is one 50 mg tablet every six hours. The TamolX is a longer acting version of the drug, used for chronic pain, with 225 mg. Since the drug can be ground up and give an instant high, it is the drug of choice.

in contrast, abuse takes larger amounts. Again from the DNAINDIA article:

The Gulf and Middle East countries, where the armed conflicts fueled growth of an illegal drug economy, demand in trafficking of powerful amphetamines and opioid painkillers from source countries like India has increased. Pills like Captagon and Tramadol are favored by militants for their sedative effects as it makes them 'invincible' during fighting.

captagon is a variation of methamphetamine with theophylline, a variation of caffine... in other words, a stimulant.

Fenethylline, also known by its brand name Captagon, is a combination of amphetamine, a stimulant, and theophylline, a drug traditionally used to treat respiratory diseases such as asthma. The latter greatly enhances the former's psychoactive properties, making the codrug a powerful amphetamine, according to scientists from the Scripps Research Institute in La Jolla, California, who published their findings in the journal Nature on Wednesday.
“It boosts the overall stimulant activity,” Cody Wenthur, the study's co-author and a postdoctoral research associate at the Scripps Research Institute, said in a statement. “You get a faster onset than other amphetamine drugs and a stronger effect than just amphetamine alone.”

more here.

alcohol and marijuana and other drugs have a long history of being used by soldiers, and may be behind a lot of the worst atrocities in war.


I remember when my father's small company was bought by a larger one that had many medically related businesses. One day, back in the 1970's, he told me he had run across evidence that his company was shipping millions of amphetamine type pills to clinics in Tiajuana... all legal, of course.

Back then, it was being used for dieting, for students trying to study hard, and by truck drivers to stay awake in long hauls. What got it banned was after a couple of bad accidents by these truck drivers, but any student could tell you of the paranoia and violence by students who did too much drugs for all nighters, i.e. 24 hour study before tests.

so the illegal drug trade not only funds terrorism, but is used by terrorists to fight.

the use of stimulents in the US military is another dirty secret: because the alternative is being sleepy and making mistakes when you fly a plane, or being too tired to fight.

the use of amphetamines goes back to World War II...

but were mainly used by Japan and Germany... a recent book discusses the widepread use in Nazi Germany not just in the military but in civilians.

But now the use of "go/nogo" pills is an open secret.

oday, American and other nations’ armed forces use more modern stimulants and sleep aids to improve performance in combat.  The policy to use these medications, however, has not always won unanimous support from military leadership.  In 1992 Air Force Chief of Staff Gen. Merrill A. McPeak banned the distribution of amphetamines to aircrew, though he admitted that his decision was not based on science but only his own personal experiences as a pilot.  The practice was reinstated by the USAF in 1996 when Gen McPeak left his position as USAF Chief of Staff.2  In the aviation community, these meds are often better known as ‘Go’ and ‘No-Go’ pills.

NYTimes article on the problem (2012) wonders if the increased use of stimulents has increased the rate of PTSS.

Because norepinephrine enhances emotional memory, a soldier taking a stimulant medication, which releases norepinephrine in the brain, could be at higher risk of becoming fear-conditioned and getting PTSD in the setting of trauma. This possibility is supported by both animal and human studies.

Finally, the fact that China is looking the other way when their drugs kill people (both opioids in the US and stimulents throughout asia) is an open secret.

One commetator quipped that the opioid crisis in the US was China's payback for the Opium wars when Britain forced them to buy opium.

But here in the Philippines, it is the meth/stimulents/ "shabu" that is the problem.

The drug war gets all the press, but the murders by druggies do not.

For example, over the last few years, several older people were killed in home robberies, which in the past would have been non violent. Were drugs involved?

A young lady across the street died of a "heart attack". she had once bee in jail for drug pushing, and it was suspected the heart attack was a drug related overdose.

Or one of our cousins shot his brother and killed him. The Brother was angry at this first brother for something, and one night, he was "drunk" and attacked him while he was sleeping. The sleeping brother always kept a shotgun by his bed so grabbed it and shot.  Shotguns are not usually fatal, but in close range, it hit an artery in his leeg and he bled to death.

Alcohol might have been enough to fuel the anger of the dead man, of course, but with all the shabu locally, I wonder if he wasn't doing that also.

Sigh.

In other words, the "human rights" folks are up in arms about the drug war, but not about drug crime.

Ditto for the local Catholic church which worries about the "poor", the Pope's "green" agenda, and about dead drug dealers, but not about the poor becoming addicted.

 the bile quote is:

English Standard Versionnor did they repent of their murders or their sorceries or their sexual immorality or their thefts.

Sorcery in the good old days was often taking drugs to see visions: using "religion" as an excuse to get high.

Drugs were around back then.
of course they also used drugs as... medicines.

One of the passages in the Odyssey was when Helen mixed some Egyptian drugs into the wine so her husband and the other soldiers could forget their sad memories.

So the drug treatment of PTSS has a long history too.

Californaa crazy

----  ban leaf blowers and lawn mowers -----


--- don't build toilets because it is their right to defecate on the streets and spread disease.

Doctors and nurses here are grappling with a population that’s extremely challenging to work with, or even find. Because homeless people are transient and receive little regular health care, even severe illnesses can go unnoticed and untreated for long periods. In the case of hepatitis A, this allows a carrier to keep spreading it. Issues such as mental illness and a deep culture of mistrust of the government also make many homeless patients difficult to reach or reason with. Many routinely turn away offers of free vaccines or medical attention.
“This is new territory,” said Dr. Wilma Wooten, San Diego County’s public health officer. “It’s challenging on so many levels.”

this angers me in so many ways.

This is not "new territory. This is basic public health prevention, and should have been addressed last year.

I suspect it is either political correctness or incompetency on her part.

Reminds me of the early chapters in Ringo's book the Last Centurian, where the Public health docs in California follow all the rules instead of common sense getting people the flu vaccine as quickly as possible.
and this was a priority for the IHS: and yes, they have emergency reponse teams.

Their job was supplying clean water and sanitation to the remote areas on Indian reservations in the USA.
It must be successful: When I worked with them in the early 1980's we still saw salmonella and typhoid, but I didn't see this when I worked in these same areas 15 years later.

sanitation, cleaning up garbage, providing sewers and clean water are more important than penicillin or even vaccinations.

the first thing that the military learns to do is keep the camp sanitary (yes, this is in the Bible and also a basic idea in Roman military camps, so it is not new).

military Field sanitation team site there are courses available.

one of the ironies of the Haitian earthquake in 2010 was that some of the UN peacekeepers from Nepal were cholera carriers. Alas, they built their latrines where the ground water would drain into a nearby river used by locals for drinking water: The result was a cholera epidemic that killed almost 10 thousand people and is still going on there.

wikipedia article.

AlJ report here.

also here;



NYTimes article from this year is mainly about the lawsuit of course.

 Studies showed the cholera bacteria came from poor sanitation by the peacekeepers. The United Nations never acknowledged it was at fault, and even when Mr. Ban apologized last December for its failure, he worded the apology to avoid any mention of who had brought the cholera to Haiti, the Western Hemisphere’s poorest country.

ratss

according to Physorg, the brown rat originated in SE Asia and spread theoughout the world via ships.

https://nhm.org/nature/blog/black-rats-brown-rats-and-plague

there are six lineages of black rat, however and they also probably came from Asia, and are most famous for being the rodent behind the spread of the black death:

“Black Rats are carriers of many different human diseases, including plague, typhus and leptospirosis,” says CSIRO mammal expert Dr Ken Aplin, lead author of the study.
Read more at: https://phys.org/news/2008-02-globetrotting-black-rat-genes-reveal.html#jCp

some attribute the decrease in plague in Europe to the fact that they discplaced the plague carrying black rat... but Wikipedia isn't sure.

The original carrier for the plague-infected fleas thought to be responsible for the Black Death was the black rat, and it has been hypothesized that the displacement of black rats by brown rats led to the decline of bubonic plague.^[85] This theory has, however, been deprecated, as the dates of these displacements do not match the increases and decreases in plague outbreaks.^[86]

but you can catch other diseases from them: again, Wikipedia.

brown rats may carry a number of pathogens,^[76] which can result in disease, including Weil's disease, rat bite fever, cryptosporidiosis, viral hemorrhagic fever, Q fever and hantavirus pulmonary syndrome.  

Weil's disease is also called leptospirosis, and is a major problem here in the Philippines after flooding. People wade through shallow water, but the spirochete can enter through wounds in the skin.

it is treatable with antibiotics, but often in times of major flooding, folks don't get around to getting treatment in time: so the gov't puts out reminders about seeing a clinic or doc if you get a fever.

Plagues and other disease in the news.

Link

marburg virus (spread by ?) and Black death/plague (spread by fleas and also air borne in this epidemic) in Africa.

CDC course on biosafety

ukIndependent article on different hazmat suits.

you know, the "modern" folks always ridicule those superstitious docs of the middle ages for using the medieval equivalent of a biosuit, but I wonder if it did work: Covered the body so no flea bites, and the herbs in the beak which were supposed to filter the germ might indeed have filtered the bacteria in pneumonic flu.

Reuters

--------------

but epidemics aren't just for Africa anymore:

SanDiego, a year after a Hepatitis A epidemic hit, is finally goin officially after the source of the epidemic: Homeless camps. (private NGO's have already tried to help them, but now it's official).

City officials said, so far, clean-ups have taken place on two dates in locations around Qualcomm Stadium, with more are to come.

Homeless outreach teams with the San Diego Police Department have also conducted outreach efforts in recent months along the river that included offering hepatitis vaccinations and access to shelter services.

“Our crews will continue to make progress cleaning the city’s portion of the San Diego Riverbed,” said Mario Sierra, director of the environmental services department. “Many areas are challenging because of topography, vegetation and access, but we must do what we can to ensure the river is as free from debris and trash as possible.”

Late last month, behind a Kaiser Permanente medical office building, a well-entrenched homeless camp of about five tents sat tucked out of sight along the San Diego River. “With them cracking down downtown so bad, we’re getting over populated down here,” said a 27-year-old living on the river who identified himself as Rabbit. Rabbit points out bags of trash piled up around his tent and the colorful mess that is a typical river camp — evidence, he said, that folks have tried to keep the area somewhat tidy.

"tidy"? Hell. The city has the right to arrest or forcibly remove both the people and the trash: and arrest the if necessary.


you know, it used to be you could do this for the sake of public safety, (one is reminded when Honolulu stopped a plague epidemic by buning down China town, the source of the disease).

and in th past, doctors could inspect hookers, and close bars which were the source of STDs, including bathhouses where gays would have multiple sexual contacts.

but after the gays got upset and arranged a "recall vote" against Mayor Feinstein because she tried to shut down the bathhouses because of an epidemic of syphillis, Hepatitis B, and other diseases, now that is against "civil rights".

The result of that action, of course, was hundreds of deaths from HIV...

Something to remember when the gay lobbies place "ain't it awful" stories about homophobia when foreign countries raid and shut down bars that are a source of disease.

ironically, few "gays" have protested how Cuba prevented an HIV epidemic by quarantining their soldiers who returned from Africa with the infection. Guess communists get a pass on such things.

An aside note: a US teen magazine aimed at teenaged girls had a how to do it guide to sodomy... never mind that this spreads disease and is humiliating for most women. The good news is that the magazine has now shut down, maybe because of a boycott.

It used to be you were a prude to say it's okay to say no, but now with the Weinstein/Hollywood/Spacey stories in the news, the victims who were shamed in the past to agree to sex, or who lost jobs because they refused, are now hitting back.

Why, yes. That is why the rules were devised in the first place: not to stop your fun but to protect you from predators and sociopaths.

there is a quip that the sexual revolution was won by the bad boys, but now the ones they hurt are getting their revenge.