Body Horrors: Big Things Have Small Beginnings

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Hello everyone! I’m stepping out from behind the curtain to share some very big news: Body Horrors has a brand new home at Discover Magazine!

I know. I know! It’s terribly exciting! I’m elated and nervous and so very humbled to have my blog hosted by this fine institution, not to mention having this incredible opportunity to continue developing as a science writer and infectious disease scholar. Today in my “hello world!” post at the blog’s new home I wrote,

I began Body Horrors as an experiment in writing about the public health of infectious diseases and parasites – an experiment that is still running today, a carefully cultured organism that’s constantly evolving and growing.

Without the curiosity and interest of my readers, yes you!, this blog wouldn’t be the vibrant, thriving organism (or is it a parasite?) that it is and so I want to thank you for visiting, reading and commenting on my articles. Thank you thank you thank you! I know the reaction of some people to the content (viruses! microbes! parasites! oh my!) of this blog is this so I appreciate you hanging in there. Your visits and comments are greatly appreciated, truly. I put a tremendous amount of research into my articles as well as a fair amount of pre-publishing agony and anxiety over tone and sentences and images – you wouldn’t believe how much time I spend coming up with pun-riddled titles – and it’s gratifying to know that not only do people enjoy my work but that they’re learning from it. I am continually in awe that people get a kick out of the things I write. So thank you.

I’ll be doing very much of the same sort of gig at Discover that I’ve always done: writing about the history, sociology and anthropology of infectious diseases and parasites to ultimately figure out just how are we humans managing and molding the presence of infectious diseases in society and vice versa, which is otherwise known as the practice of “public health”:

This is the most complex and fascinating component of our relationship with the bacteria, viruses and parasites that we coexist with – how do we as a society educate ourselves on preventing and controlling disease and can we change our own behaviors so as to do so more effectively? Not only do these public heath needs serve as some of the most difficult challenges we face today (see: polio eradication) but they also have the potential to be the most enlightening and innovative achievements that humans can accomplish, ever since Antonie van Leeuwenhoek found squirming animalcules under a microscope and since John Snow controlled the 1854 cholera outbreak in London. It’s not rocket science but it is human science and that is also what this blog about – a celebration of the intersection between humans and microbiology.

I’ll also be starting up a recurring series of articles over there called “Microbial Misadventures,” detailing unfortunate mishaps where human meets microbe in novel and unusual circumstances that challenge our assumptions about how diseases are spread. Here’s just a hint of an upcoming  article: anthrax, hippies and drum circles. See? I told ya it’s gonna be good.

Remember: both microorganisms and humans need nutrients, love and a petri dish to grow so I do hope you’ll join me in my blogging (mis)adventure and venture over to Body Horrors at Discover! Sadly, in a week or two I’ll be shutting this ol’ girl down and making the final, permanent move to Discover. So go! Go to Discover! Godspeed!

Thoughts on the New Bird Flu H7N9 & It’s Animal Connection

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Much of the United States is mesmerized by the belligerent squawks from North Korea’s Kim Jong-un and the volatile tension straddling the Korean peninsula, but I’m more concerned about what is happening in China right now and the troubling trickle of news on a new bird flu strain H7N9.

At least 16 people have been infected, patients who were widely distributed through the geographic enormity that is China, and already six have died. But what makes this small cluster of flu cases unusual is its timing – we usually see flu outbreaks emerging in the fall and winter months and we are just now breaking into the month of April – and that this type of flu strain is not known to infect humans.

H7N9 seems to be following a well established pattern of other emerging viruses: originating in east Asia, the infection appears to have a tentative association with wet markets and butchering, and is of zoonotic or animal origin. We’ve seen this situation previously with Nipah virus in Malaysia infected pigs and slaughterhouse employees and with SARS and its birth in the wet markets of Guangdong Province in China.

Laurie Garret masterfully crafts an unnerving story, of unknown unknowns regarding these human flu cases and the potential linkage between the thousands of pigs and fowl carcasses that clogged Chinese waterways in March.

Here’s how it would happen. Children playing along an urban river bank would spot hundreds of grotesque, bloated pig carcasses bobbing downstream. Hundreds of miles away, angry citizens would protest the rising stench from piles of dead ducks and swans, their rotting bodies collecting by the thousands along river banks. And three unrelated individuals would stagger into three different hospitals, gasping for air. Two would quickly die of severe pneumonia and the third would lay in critical condition in an intensive care unit for many days. Government officials would announce that a previously unknown virus had sickened three people, at least, and killed two of them. And while the world was left to wonder how the pigs, ducks, swans, and people might be connected, the World Health Organization would release deliberately terse statements, offering little insight.

By the end of March, at least 20,000 pig carcasses and tens of thousands of ducks and swans had washed upon riverbanks that stretch from the Lake Qinghai area all the way to the East China Sea — a distance roughly equivalent to the span between Miami and Boston. Nobody knows how many more thousands of birds and pigs have died, but gone uncounted as farmers buried or burned the carcasses to avoid reprimands from authorities.

We are very early into this developing scenario and this spate of cases could fizzle into just a blip in the news cycle and on the infectious disease radar. You should read Maryn McKenna’s reasoned and calm analysis here and to devour a slew of delicious infectious disease geek resources at the tail end of her article.

The point I want to make here is a reminder of how closely intertwined the lives of humans are with the lives of the animals we breed and eat. Not many of us raise pigs in the backyard or hear the cock’s crow in the morning and it’s easy to forget that for thousands of years we have lived in close proximity to our poultry and livestock.

But this is still the case in developing nations and particularly those with industries reliant on raising and butchering animals for the global market as well as people supporting a family with their hens and chicks. It is these people and places that are at most risk of emerging zoonotic infections like H7N9 and they require careful surveillance and monitoring of the health and well-being of both people and animals. Remember: catching a novel disease from an animal is the rule not the exception.

Resources

The most important link I can give you: “The New Bird Flu, And How To Read The News About It” from Maryn McKenna.

A timeline of events from Laurie Garret’s article “Is This a Pandemic?” in the short news cycle of H7N9. Her article can be accessed here.

Shanghai will be temporarily closing its live poultry markets on Saturday due to fears of a spreading H7N9 .

A Nepalese Odysseus: XDR-TB is in South Texas

The Wall Street Journal has a superb write-up of a Nepalese man infected with extremely drug resistant tuberculosis (XDR-TB) who is currently detained at the US border in South Texas. XDR-TB is resistant to four of the major types of antibiotics that are used to treat and control TB infections and this man is the first person with this particularly dangerous strain of TB  to cross the border and be quarantined in this country (1).

Traveling in all of the modern ways known to man – by foot, car, boat and plane – the man ventured from his home in Nepal, traipsing through South Asia, flying to Brazil and hoofing it through Central America until reaching the southernmost tip of Texas.

From the WSJ,

His three-month odyssey through 13 countries – from his homeland of Nepal through South Asia, Brazil, Mexico, and finally into Texas – shows the way in which dangerous new strains of the disease can migrate across the world unchecked.

The Nepalese patient was taken into custody by the U.S. Border Patrol in late November as he tried to cross the border illegally near McAllen, Texas, according to Department of Homeland Security officials. The government declined to name him. He was transferred five days later to an Immigration and Customs Enforcement detention facility in Los Fresnos, Texas, and put into “medical isolation” with suspected tuberculosis.

 His XDR strain has been seen only once before in the U.S., in another patient of Nepalese origin, according to the government description.

A map of the U.S. Quarantine Stations. Staffed with quarantine medical and public health officers from CDC, they're located at 20 ports of entry and land-border crossings where international travelers arrive. Image: CDC. Click for source.

A map of the U.S. Quarantine Stations. Staffed with quarantine medical and public health officers from CDC, they’re located at 20 ports of entry and land-border crossings where international travelers arrive. Image: CDC. Click for source.

Our Nepalese man has innocently launched a global public health dilemma: of the potentially thousands of people that this man came across in his odyssey, who else has he infected? It will be a herculean and futile task for public health officers as many of the people that he may have passed on this pathogen are in a similar socioeconomic, nomadic situation – fellow tenacious migrants that quickly move from one place to another in their journey for economic sanctuary and personal salvation.

This case is a powerful reminder that globalization and innovations in travel have radically changed the rules of the game for dangerous and communicable infectious diseases. Of the 950,000 international travelers that arrive in the United States every single day, good public health institutions like the US quarantine stations scattered throughout the country are vital to monitoring hitch-hiking drug-resistant pathogens (2).

Please click here to read the WSJ’s article “Dangerous TB Patient Detained on U.S. Border.”

Note: To be specific, XDR-TB is resistant to the two first-line drugs, isoniazid and rifampin, used to treat TB initially, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).

Resources

A fact sheet from the CDC on XDR-TB.

Reference

(1) B McKay (March 1, 2013) Dangerous TB Patient Detained on U.S. Border. Wall Street Journal. Accessed on March 7, 2013 here.

(2) CDC (August 3, 2012) Public Health Interventions Involving Travelers with Tuberculosis — U.S. Ports of Entry, 2007–2012. MMWR. 61(30); 570-573.

ResearchBlogging.org
Centers for Disease Control and Prevention (CDC) (2012). Public health interventions involving travelers with tuberculosis–U.S. ports of entry, 2007-2012. MMWR. Morbidity and mortality weekly report, 61 (30), 570-3 PMID: 22854625