Three Infections You Should Worry About More Than Ebola
Our nation has been struck with Ebola fever— not literally, of course, but rather a rising tide of fear that the virus will sweep across the United States. In fact, since the first case cropped up in Texas, tracking Ebola has become something of an American obsession— and not a healthy one.
“The idea that Ebola will take over the United States is an unfounded fear,” said Dr. Liise-Anne Pirofski, chief of infectious diseases at Albert Einstein College of Medicine. Because the incubation period is relatively brief— only 2 to 21 days —Ebola isn’t likely to spread undetected and suddenly emerge in vast numbers, added Dr. Robert Schooley, chief of infectious diseases at the UC San Diego School of Medicine. As for the Ebola case in Texas? “I think it was very much an exception,” he told Yahoo Health, adding: “It’s a threat in any place that airplanes can land, but we have the means to prevent it from spreading. I don’t see Ebola as the biggest infectious-disease worry for the people that I take care of.”
Related: Say Hello to the Latest Mosquito-Borne Virus: Chikungunya
So what should we be worried about? It’s tough to predict since it is the unpredictability of certain bacteria and viruses that often makes them so alarming, Schooley said. But there are some existing viruses and bacteria that pose an ongoing threat— and that you’re much more likely to catch than Ebola.
The flu doesn’t have an exotic, tropical-sounding name— and we are able to vaccinate against it with some degree of efficacy. Yet it is still a major killer in the United States. “More people will die this winter from the flu than Ebola,” said Schooley. Influenza does pose a very real, mortal threat, “particularly because we’re never able to predict with 100 percent certainty which strains will be circulating,” said Pirofski.
In fact, as recently as 2009, a strain emerged that wasn’t covered by the vaccine. And it wasn’t just the normal populations of concern— the very young and the elderly —that were struck down, said Pirofski. An unusually high number of people in the prime of their life were affected. The reason: In some cases, young, healthy people’s immune systems may respond too exuberantly to the flu virus, and the resulting inflammation may actually exacerbate the illness, explained Pirofski.
There are an estimated 75,309 cases of methicillin-resistant Staphylococcus aureus, or MRSA, infection in the United States, according to CDC tracking data. Compare that to one currently confirmed case of Ebola in the United States. What exactly is MRSA? Simply put, it’s a strain of staph bacteria that doesn’t respond to the antibiotics traditionally used to treat the infection.
“Antibiotic resistance is a major threat,” said Pirofski. “By definition, these organisms can’t be controlled with existing therapies, and they are very entrenched in some of our larger cities and more advanced tertiary- care hospitals. You don’t have to go to West Africa to get them —you can go to your local hospital, or maybe even some other health-care provider settings, and you can acquire these organisms.”
Although MRSA infections in hospitals are on the decline, a CDC study revealed that the resistant bacteria is still capable of causing life-threatening infections, particularly in hospital patients.
An estimated 820,000 new cases of gonorrhea crop up in the United States each year, and now, we’re grappling with a form of the bacteria that doesn’t respond to the treatments we’ve long relied on. In the early 2000s, strains of gonorrhea resistant to cephalosporins— the antibiotics used as the primary defense against the sexually transmitted infection —began to show up in East Asia. Now, the resistant bacteria are here— a problem the CDC calls “an urgent threat.” “[Resistant gonorrhea] has really emerged as a concern in the United States more recently,” Pirofski told Yahoo Health. According to a 2013 CDC report, there are an estimated 246,000 cases of resistant gonorrhea in the country each year.
And alarmingly, many people, particularly women, who are infected don’t show any symptoms (or have only very mild ones), giving resistant gonorrhea the potential to easily spread. “We really do not know what causes some people to become very ill and some to just [harbor] it,” said Pirofski. “But even people that just [harbor] it are capable of transmitting it. That’s a huge problem.”
Although it rarely kills people, when left untreated gonorrhea can cause pelvic inflammatory disease and infertility in women. And, according to the CDC, it can spread to the blood, resulting in a potentially life-threatening condition called disseminated gonococcal infection, which is characterized by arthritis, inflammation of the tissue covering tendons, and dermatitis.
Say Hello to the Latest Mosquito-Borne Virus: Chikungunya
Scientists knew it was coming, and now it’s here: The first U.S. cases of chikungunya, a virus carried by mosquitoes that can cause fever and joint pain, have surfaced in a Florida man and woman who have not traveled to any of the foreign countries where the disease is common, according to the Centers for Disease Control and Prevention (CDC). The two cases indicate that the virus may begin to pop up more frequently in the region.
Chikungunya has historically been limited to countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. But it made its way to the Western Hemisphere last December, when Puerto Rico and the U.S. Virgin Islands reported 121 and two cases, respectively, of the locally acquired virus. And while cases have certainly appeared in people in the U.S. before, those have always been travel-related instances, CDC arboviral disease chief Roger Nasci told Yahoo Health. These new cases indicate that a local mosquito bit someone who had carried the virus from another country; then said mosquito bit another person, spreading the disease locally.
Two species of mosquitoes spread the virus — Aedes aegypti (the same critter to blame for spreading dengue fever) and Aedes albopictus, both of which are found in the southeastern U.S. and parts of the Southwest. A. albopictus also resides farther up the East Coast through the Mid-Atlantic States, as well as in the lower Midwest region. The best way to avoid chikungunya, Nasci stressed, is to avoid mosquito bites by wearing repellent and long sleeves and making sure that window screens are in good condition. In this case, though, staying inside at dusk won’t help much, as these particular types of mosquitoes feed during the day.
CDC officials expect that chikungunya will behave like dengue in the United States, where imported cases have resulted in sporadic local transmissions without triggering widespread outbreaks. None of the more than 200 imported chikungunya cases between 2006 and 2013 have triggered a local outbreak.
Chikungunya joins another scary-sounding disease enjoying the limelight this week: babesiosis, a malaria-like illness caused by microscopic parasites that infect red blood cells and are spread by certain ticks. Six cases were reported in New Jersey on Thursday, with five other suspected cases being investigated, according to the Ocean County Health Department. Though not everyone who gets infected develops symptoms, babesiosis can cause fever, chills, body aches, and nausea; it can also lead to complications that include hemolytic anemia, unstable blood pressure, and even death — particularly for at-risk patients such as those who are elderly or living with compromised immune systems.
The chikungunya-babesiosis news is not exactly the most welcome for those who are already anxious about mosquitoes and ticks as they try to avoid illnesses such as West Nile virus and Lyme disease. Still, notes Nasci, “there’s absolutely no reason to panic. That’s always the challenge of getting a story out with information about a new disease.”
CDC Director Tom Frieden Talks Flu Vaccines
Here’s why you want to get immunized.
By Lisa Esposito
Tom Frieden, director of the Centers for Disease Control and Prevention, believes in influenza immunization. So he rolled up his sleeve and got his own flu vaccine – in front of fellow physicians and members of the audience at a recent conference at the National Press Club in the District of Columbia.
While the CDC has announced a guideline shift for kids’ flu vaccines, as well as for pneumococcal vaccines for seniors, Frieden’s main message is this: Everyone 6 months and older should get a flu shot, every year. He talked about vaccine options – including nasal spray, small-needle injections and “less-small needle injections,” which drew some smiles at the National Foundation for Infectious Diseases-sponsored conference. The reaction was more somber to the news that more than 100 children in the U.S. died from flu-related complications last year.
In a pre-conference talk with U.S. News, Frieden discussed the need to get the vaccine at any age, and how health care providers can make that easier. He’s already taken his 10-year-old son for one, and of his 20-year-old son in college, Frieden noted, “He went to the clinic last year to get Tylenol for a headache – and they told him you can’t get Tylenol until you get a flu shot.”
Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, receives a flu shot at the National Press Club. Photo by AP.
Here’s more of what Frieden had to say throughout the morning.
Do you expect to see new flu strains this year?
We can’t predict what this season is going to look like – more severe or less severe. We can’t predict which strains are going to be circulating, but we can predict that the best way you can protect yourself against the flu is to get a flu vaccination this year, and now’s the time to start getting it.
You may remember  was a relatively bad year for flu. There were tens of millions of illnesses. Lots of people went to the hospital. It hit young adults and middle-aged people harder than it usually does, and they accounted for a larger proportion of cases. Last year it was predominantly the H1N1 strain that first emerged in 2009. That strain remains in this year’s flu shot. And you need this year’s flu vaccination to protect you against this year’s flu.
How well do flu vaccines really work?
It’s not a perfect vaccine, but it’s a safe vaccine, and it’s the best way to protect yourself from flu. It protects almost two-thirds of the time. So we’d love it to be 100 percent or 95 percent like many of our vaccines – but it’s a lot better than hope. It’s a lot better than luck. So if you get it, your risk of getting the flu is cut down by more than 60 percent. It’s a safe and effective vaccine. I get it, my family gets it [and] I recommend that pregnant women get it.
New this year: We’re preferentially recommending nasal spray vaccine for healthy children 2 to 8 years old who don’t have any contraindications or precautions, when it’s available immediately. But if it’s not available immediately, by all means get any available form of flu vaccinate – they all work.
Of children who died from flu, how many were not vaccinated?
Of those more than 100 kids who died of flu, first off – we know that the actual number’s higher, [but] we’re not able to identify each such tragic event. And we know that about half those kids didn’t have a pre-existing condition. So they didn’t have some health problem that would have identified them as high-risk.
We know that the overwhelming majority, about 90 percent, didn’t get a flu shot. So please, get a flu shot for yourself and your kids this year and every year. There are many more options for flu vaccination.
Doctors can do a lot here. It increases the vaccination rate as doctors make it routine and easy for kids to get vaccinated. [In many of the cases when kids weren’t vaccinated], it wasn’t that the parent didn’t want a vaccine – it’s just that the system didn’t work for them.
How about enterovirus?
It’s very important that kids with asthma get the flu vaccine, because that will protect them from flu – and some of the most severe cases of enterovirus D-68 have been in kids with asthma that hasn’t been well controlled.
[Note: During the conference, pediatrician Paul Offit, director of the Vaccine Education Center at The Children’s Hospital of Philadelphia, emphasized that despite recent clusters of respiratory illness from enterovirus, flu poses a much wider and graver risk.]
Will there be enough flu vaccine?
We’re confident that there will be ample supply this year. We’re told by the manufacturers that they’ll be bringing about 150,000 doses of vaccine to the market.
There is plenty of flu vaccine to go around – we hope everyone will take advantage of it.
Sheets, towels, TV remotes key reservoirs for MRSA contamination
By Anne Harding
NEW YORK (Reuters Health) – Surfaces in households of children with MRSA infections are often contaminated with the same strain of bacteria, according to new findings.
Contamination was found most frequently on bed linens, TV remote controls, and bathroom hand towels, Dr. Stephanie A. Fritz of Washington University School of Medicine in St. Louis and her colleagues report in JAMA Pediatrics.
MRSA stands for methicillin-resistant Staphylococcus aureus, a kind of bacteria that can’t be controlled by common antibiotics. At one time, MRSA infections were mostly “caught” by hospital patients, but lately people have been acquiring it even outside of healthcare settings.
“Household environmental sources are reservoirs of Staphylococcus aureus isolates that cause infection in children,” Fritz told Reuters Health.
While the new study could not show whether the children were contaminating these surfaces, or catching the infection from the surfaces, she and her colleagues are conducting a two-year follow-up study that they hope will provide answers.
Skin and soft tissue infections with MRSA often recur, Fritz and her team note in their report. In an earlier study of theirs, treating household members of a child with MRSA, in a procedure known as “decolonization,” reduced recurrence of the infection compared to decolonizing the child only – but during the next year, the infections reoccurred in half of the patients in the study.
To determine whether household surfaces might be a reservoir for infection, the researchers enrolled 50 children with active or recent community-acquired MRSA. They sampled the nostrils, armpits and groin of each child to detect colonization, as well as 21 household surfaces and pet dogs and cats. All identified strains were typed to identify relatedness within households.
The researchers found MRSA in 23 of the 50 households, with the most frequently contaminated surfaces being bed linens (18 percent), TV remotes (16 percent), and bathroom hand towels (15 percent). Twelve percent of dogs and 7 percent of cats also were colonized with MRSA.
In 20 households, the researchers identified at least one surface contaminated with the same strain as that isolated from the patient.
Cleaning frequency was not associated with the likelihood of finding S. aureus on household surfaces, but Dr. Fritz noted that study participants may not have responded accurately to questions about cleaning frequency, and also were not asked which cleaning products they used.
“These environments do likely play a role in the transmission between the household members, and may play a role in the development of infection,” Fritz said. It’s not clear, though, she added, whether “targeted cleaning” of those surfaces will decrease the spread of infection.
In an editorial published with the study, Dr. Aaron Milstone of Johns Hopkins Children’s Center in Baltimore wrote that about 30 percent of children who develop skin and soft tissue infections with MRSA have recurrence of the infection, he told Reuters Health.
The findings “show that there’s a clear link between what people have and what’s in their environment,” he said. “The big question is can we improve that, is cleaning really going to make a difference in the long term. I do applaud them for chipping away at this, because it’s a big public health problem. I look forward to the next steps.”
“What I would say to my patients, which is a simple message, is it’s not going to hurt to clean your house. We don’t know yet if that’s going to prevent the problem,” he added. “This study doesn’t show that if people clean their houses compulsively and fanatically the problem is going to go away.”
The findings do show, he added, that pets are not likely to be an important reservoir of MRSA. “Don’t get rid of your dog in an attempt to cure this.”
SOURCE: http://bit.ly/1rzk2fx JAMA Pediatrics, online September 8, 2014.
Basic Fact Sheet
Detailed fact sheets are intended for physicians and individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.
What is gonorrhea?
Gonorrhea is a sexually transmitted disease (STD) caused by infection with the Neisseria gonorrhoeae bacterium. N. gonorrhoeae infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. N. gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes, and anus.
How common is gonorrhea?
Gonorrhea is a very common infectious disease. CDC estimates that, annually, 820,000 people in the United States get new gonorrheal infections, and less than half of these infections are detected and reported to CDC. CDC estimates that 570,000 of them were among young people 15-24 years of age. In 2012, 334,826 cases of gonorrhea were reported to CDC 2.
How do people get gonorrhea?
Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread perinatally from mother to baby during childbirth.
People who have had gonorrhea and received treatment may be reinfected if they have sexual contact with a person infected with gonorrhea.
Who is at risk for gonorrhea?
Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans 2.
What are the signs and symptoms of gonorrhea?
Many men with gonorrhea are asymptomatic 3, 4. When present, signs and symptoms of urethral infection in males include dysuria or a white, yellow, or green urethral discharge that usually appears one to fourteen days after infection 5. In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain.
Most women with gonorrhea are asymptomatic 6, 7. Even when a woman has symptoms, they are often so mild and nonspecific that they are mistaken for a bladder or vaginal infection 8, 9. The initial symptoms and signs in women include dysuria, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements 10. Rectal infection also may be asymptomatic. Pharyngeal infection may cause a sore throat, but usually is asymptomatic 11, 12.
What are the complications of gonorrhea?
Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). The symptoms may be quite mild or can be very severe and can include abdominal pain and fever 13. PID can lead to internal abscesses and chronic pelvic pain. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.
In men, gonorrhea may be complicated by epididymitis. In rare cases, this may lead to infertility 14.
If left untreated, gonorrhea can also spread to the blood and cause disseminated gonococcal infection (DGI). DGI is usually characterized by arthritis, tenosynovitis, and/or dermatitis 15. This condition can be life threatening.
What about Gonorrhea and HIV?
Untreated gonorrhea can increase a person’s risk of acquiring or transmitting HIV, the virus that causes AIDS 16.
How does gonorrhea affect a pregnant woman and her baby?
If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby 17. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary.
Who should be tested for gonorrhea?
Any sexually active person can be infected with gonorrhea. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should stop having sex and see a health care provider immediately.
Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.
Some people should be tested (screened) for gonorrhea even if they do not have symptoms or know of a sex partner who has gonorrhea 18. Anyone who is sexually active should discuss his or her risk factors with a health care provider and ask whether he or she should be tested for gonorrhea or other STDs.
People who have gonorrhea should also be tested for other STDs.
How is gonorrhea diagnosed?
Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT) 19. It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.
If a person has had oral and/or anal sex, pharyngeal and/or rectal swab specimens should be collected either for culture or for NAAT (if the local laboratory has validated the use of NAAT for extra-genital specimens) 20.
What is the treatment for gonorrhea?
Gonorrhea can be cured with the right treatment. CDC now recommends dual therapy (i.e. using two drugs) for the treatment of gonorrhea. It is important to take all of the medication prescribed to cure gonorrhea. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Antimicrobial resistance in gonorrhea is of increasing concern, and successful treatment of gonorrhea is becoming more difficult 21. If a person’s symptoms continue for more than a few days after receiving treatment, he or she should return to a health care provider to be reevaluated.
What about partners?
If a person has been diagnosed and treated for gonorrhea, he or she should tell all recent anal, vaginal, or oral sex partners (all sex partners within 60 days before the onset of symptoms or diagnosis) so they can see a health provider and be treated 20. This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also reduce the person’s risk of becoming reinfected. A person with gonorrhea and all of his or her sex partners must avoid having sex until they have completed their treatment for gonorrhea and until they no longer have symptoms. For tips on talking to partners about sex and STD testing, visit http://www.gytnow.org/talking-to-your-partner.
How can gonorrhea be prevented?
Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea 22. The surest way to avoid transmission of gonorrhea or other STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
Where can I get more information?
Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
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