Healthsifter by mary desmond pinkowish, since 2003

Teen Girls: Lots of Sexually Transmitted Infections

The current issue of the journal Pediatrics has the results of a survey of a representative sample of more than 800 girls aged 14 to 19 years who were interviewed, had physical exams, and were tested for five sexually transmitted infections (STIs): Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, herpes simplex virus type 2, and any of the high-risk types of human papillomavirus (HPV).  The findings as presented in the article's summary:

"Prevalence of any of the 5 STIs was 24.1% among all and 37.7% among sexually experienced female adolescents. HPV (23 high-risk types or type 6 or 11) was the most common STI among all female adolescents (prevalence: 18.3%), followed by C trachomatis infection (prevalence: 3.9%). Prevalence of any of the STIs was 25.6% among those whose age was the same or 1 year greater than their age at sexual initiation and 19.7% among those who reported only 1 lifetime sex partner."

So about one-quarter of adolescent girls have at least one STI, and the risk is significant even if the girl has had just one sex partner. She may have had just one partner, but he's infected, she soon will be. The word should get out. This research was conducted at the CDC.

Flu: Who Dies and Why

Why do some people remain healthy in the midst of epidemics? That mystery has been with us forever, and Jerome Groopman and Pamela Hartzband write about it in today's New York Times. Take H1N1 flu, for example. Think you're in a good place because you don't have an underlying condition, or UC? You're definitely in a better place without asthma or diabetes, but 25% of people who've been hospitalized with H1N1 and one third of the children who've died of the infection did not have a UC, according to Groopman and Hartzband. Other people have almost certainly been exposed to the virus and haven't even gotten sick, let alone been hospitalized or died. These patterns have been observed in other flu epidemics and during the great plagues throughout history, when one's continued good health while the neighbors were dying of smallpox was considered a sign of divine intervention. I'm all in favor of divine intervention, but what gives? As this article explain, studies of HIV infectivity may hold some clues. Interesting stuff. 

Travel Medicine and Vaccines: It's Not Just About Swine Flu

A bit overwrought...

In her column in today's Wall Street Journal, Laura Landro reminds us that Swine flu is the least of the health problems that travelers may encounter this summer. Here's an excerpt:

While swine flu has dominated the news as a concern for travelers, experts say other infectious diseases pose a far greater threat as the summer travel season gets under way. Especially worrisome are mosquito-borne diseases, including malaria, dengue fever, Japanese encephalitis, chikungunya fever and yellow fever, which are now spreading in areas where they weren't previously a danger. Travelers are also at increased risk for intestinal and skin-burrowing parasites, tick-borne diseases, sexually transmitted diseases, typhoid fever and the age-old scourge, traveler's diarrhea.

The CDC's Yellow Book is the bible of travel medicine. You can find the online version here. A new edition comes out online shortly.

How to Wash Your Hands

Really....as Melinda Beck describes in the WSJ today in a column and in a nice little video...there's more to washing your hands that you think there is. You'll learn something.

Hear Pertussis

I don't link to ads, but this is an exception: DoItForYourBaby.com: Get your baby immunized. And go to this sight for an audio of a baby coughing with this dangerous infection. Click on "Hear the Cough."

Google Flu

Read about how Google can spot flu outbreaks faster than the CDC can. According to Google, they can use their data on searches around the term "flu symptoms" to spot regional outbreaks. Have a look at their article "Flu Trends" at Google.org to see how closely their data is correlated with the more traditional data from the CDC going back to 2004. The thing is, Google is at least two weeks ahead of the CDC, meaning that consumers, doctors, and public health officials can get a heads-up sooner when the flu hits their town. This is impressive stuff and possibly the wave of the future for tracking early disease outbreaks. It makes so much sense. As they point out, they get more search requests around allergy- and sunburn-related terms in the spring and summer. What other information is out there? The Google paper will eventually appear in the journal Nature. Read the New York Times article, too.

Contrast this situation to the one when Lyme Disease first came to public attention in Connecticut in pre-web 1975. A woman in Lyme, CT named Polly Murray started making pesky phone calls to places like Yale, reporting that too many people of her acquaintance on the Connecticut coast had strange arthritis symptoms. She got doctors at Yale to pay attention, and the rest is Lyme disease history, as recounted here in a 1990 interview from the New York Times with Dr. Matthew Cartther, then an epidemiologist with the State of Connecticut: 

Q: Why did the disease start in Connecticut?

A: It didn't really start in Connecticut. That's something people need to realize. In retrospect, the first U.S. case was reported in Wisconsin, although it wasn't recognized. What happened here was a unique set of circumstances - Polly Murray, in Lyme, making phone calls and becoming aware of the increase in arthritis, then the fortuitous arrival of Dr. Alan Steere, an epidemiologist training to be a rheumatologist. He found the link between the arthritis and the skin rash, and eventually they found the tick vector and, in 1981, the bacteria that causes it. It got the name Lyme disease because the description came out of Connecticut, but the first reports are from the turn of the century in Europe.

He means turn of the 20th century--1900--in Europe.
TImes are a'changin.

MRSA Information

The CDC just launched a MRSA education initiative. They have some good general information here about the symptoms of MRSA, as well as links to other sites. Parents and educators may be interested in the link to more information about MRSA in schools.(Photo from Texas Department of State Health Services.)

Unknown, Fatal Fever in South Africa

Three people have died of a mystery illness in South Africa, as reported by the Associated Press:

"...tests have proved negative for Ebola, Lassa fever, Rift Valley fever, Marburg fever and other main types of hemorrhagic fever.

WHO spokesman Gregory Hartl says the first death on Sept. 13 was a tour guide who had fallen ill in Zambia before being evacuated to South Africa. Two further deaths on Sept. 30 and Oct. 4. involved a paramedic and a nurse who treated the woman.

Hartl said Friday that 121 people are being monitored and WHO hopes to receive further test results by Sunday.

Where is this going? The Associated Press account says that this is a hemorrhagic fever, but the WHO says that bleeding was not prominent in the victims. A report from the South African Special Pathogens Unit, National Institute for Communicable Diseases (NICD), is available here. 

Chronic Lyme versus Post-Lyme

The Johns Hopkins Health Alerts newsletter tackles the controversy over chronic Lyme and post-Lyme disease. The Infectious Disease Society of America (IDSA)says 95% of people with Lyme disease are cured by 14 to 28 days of treatment with antibiotics. Others, including lots of people with Lyme disease dispute this, hence the controversy over chronic and post-Lyme. Read more here. The IDSA FAQ on Lyme disease is here. And if you're interested, you can read the IDSA guidelines on treating Lyme Disease.

How to Survive Rabies...Maybe

Go to Scientific American and read the story of Jeanna Giese and how she survived an active case of rabies four years ago. Why is this so interesting? Jeanna is the only known survivor of rabies. If you get bitten by a rabid animal today and get immediate treatment with the appropriate vaccines, your chances of survival are excellent. You'll never develp symptoms, and you won't die.

But what happens if you don't realize you've been exposed? It's hard to ignore a racoon bite, but it's lots easier to overlook a small bat bite, for example. That's what happened to Jeanna. She and her parents never realized that she'd been exposed to the rabies virus. By the time she developed symptoms, she had one foot in the grave, so to speak. Doctors at Children's Hospital in Milwakee, knowing that she'd die unless they did something extreme, treated her in novel ways, including putting her in a coma so that her immune system could take over. They also pummeled her with antiviral medications. She survived, and her case was written up in the New England Journal of Medicine a few years ago. As many as 12 other people have been treated--unsuccessfully--since Jeanna survived. The story is back in the news now because an 8-year-old Columbian girl has been treated since August for rabies by many of the same methods. So what is it about Jeanna and her treatment? Doctors are still trying to figure that out.