'We've reached the end of antibiotics': Top CDC expert declares that 'miracle drugs' that have saved millions are no match against 'superbugs' because people have overmedicated themselves

By Snejana Farberov
PUBLISHED: 00:30 EST, 26 October 2013 | UPDATED: 01:17 EST, 26 October 2013

Health crisis: Dr Arjun Srinivasan, the associate director of the CDC, told PBS' Frontline that misuse and overuse of antibiotics over the years have rendered them powerless to fight infections

A high-ranking official with the Centers for Disease Control and Prevention has declared in an interview with PBS that the age of antibiotics has come to an end.
'For a long time, there have been newspaper stories and covers of magazines that talked about "The end of antibiotics, question mark?"' said Dr Arjun Srinivasan. 'Well, now I would say you can change the title to "The end of antibiotics, period.”'
The associate director of the CDC sat down with Frontline over the summer for a lengthy interview about the growing problem of antibacterial resistance.
Srinivasan, who is also featured in a Frontline report called 'Hunting the Nightmare Bacteria,' which aired Tuesday, said that both humans and livestock have been overmedicated to such a degree that bacteria are now resistant to antibiotics.
‘We're in the post-antibiotic era,' he said. 'There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t.’.
Dr Srinivasan offered an example of this notion, citing the recent case of three Tampa Bay Buccaneers players who made headlines after reportedly contracting potentially deadly MRSA infections, which until recently were largely restricted to hospitals.
About 10 years ago, however, the CDC official began seeing outbreaks of different kinds of MRSA infections in schools and gyms.
‘In hospitals, when you see MRSA infections, you oftentimes see that in patients who have a catheter in their blood, and that creates an opportunity for MRSA to get into their bloodstream,’ he said.

Nightmare superbug: Srinivasan said that about 10 years ago, he began seeing outbreaks of different kinds of MRSA infections, which previously had been limited to hospitals, in schools and gyms

‘In the community, it was causing a very different type of infection. It was causing a lot of very, very serious and painful infections of the skin, which was completely different from what we would see in health care.’
With bacteria constantly evolving and developing resistance to conventional antibiotics, doctors have been forced to ‘reach back into the archives’ and ‘dust off’ older, more dangerous cures like colistin.

WHAT ARE ANTIBIOTICS?

Antibiotics, also known as antibacterials, are types of drugs that destroy or slow down the growth of bacteria. 
Antibiotics are used to treat infections caused by bacteria. Bacteria are microscopic organisms, some of which may cause illness.

Before bacteria can multiply and cause symptoms, the body's immune system can usually destroy them. But if white blood cells fail to fight off the infection, antibiotics can help.

The first antibiotic was penicillin, which was discovered in 1928 by Scottish Professor Alexander Fleming.

Such penicillin-related antibiotics as ampicillin, amoxicillin and benzylpenicilllin are widely used today to treat a variety of infections.

Source: Medical News Today

‘It’s very toxic,’ said Srinivasan. ‘We don’t like to use it. It damages the kidneys. But we’re forced to use it in a lot of instances.’
The expert went on, saying that the discovery of antibiotics in 1928 by Professor Alexander Fleming revolutionized medicine, allowing doctors to treat hundreds of millions of people suffering from illnesses that had been considered terminal for centuries.

 

Antibiotics also paved the way for successful organ transplants, chemotherapy, stem cell and bone marrow transplantations - all the procedures that weaken the immune system and make the body susceptible to infections.
However, the CDC director explained that people have fueled the fire of bacterial resistance through rampant overuse and misuse of antibiotics.
‘These drugs are miracle drugs, these antibiotics that we have, but we haven’t taken good care of them over the 50 years that we’ve had them,’ he told Frontline.
Srinivasan added that pharmaceutical companies are at least partially to blame for this problem, saying that they have neglected the development of new and more sophisticated antibiotics that could keep up with bacterial resistance because ‘there’s not much money to be made’ in this field.
 

Read more:

• Hunting the Nightmare Bacteria ¿ FRONTLINE

How Dog and Cat Whiskers Work

By vetstreet.com | Pets – 4 hours ago

By Dr. Marty Becker

 

Thinkstock 

They're not just there for looks. The hairs detect air currents, send prey information and even serve as a measuring device.

My friend Dr. Tony Johnson once told me about a woman who called to say she was bringing her dog into the emergency clinic where he worked because the dog had met up with a porcupine, and she was having difficulty removing the quills. When she arrived, he discovered that she had mistaken the dog's whiskers for quills and had been pulling them out.
Ouch! Can you imagine how much that must have hurt?
RELATED: How Whiskers Are Different From Other Hair

Sensory Aids A dog's or cat's whiskers are specialized tactile hairs, sometimes called sinus hairs or vibrissae. In both pets, they're located on the muzzle, above the eyes and beneath the chin. In cats, they're also on the underside of the lower foreleg (carpal hairs).
Whiskers are amazing! They're not just there for looks. The long, stiff hairs, which are thicker than normal hairs and tapered at the tips, aid a cat's or dog's sense of touch.
Like other hairs, whiskers grow from follicles, which extend about three times deeper into the skin than the follicles of normal hair. Bundles of nerves at the base of each follicle make the whiskers exquisitely attuned to the surrounding environment.
These sensitive tactile organs can detect air currents, transmit complex information about the movement and position of prey, and even serve as a measuring device - if a cat's whiskers can fit through an opening, chances are the rest of her body will go through too. (That's one of the reasons it's important not to let your child or grandchild use a pair of scissors to play pretend groomer with a pet's whiskers.)
Just as we use our fingertips to feel around in the dark, cats and dogs use their whiskers and the carpal hairs on the lower forelegs to sense objects that they might not see during a late-night prowl. The air stirred up by the animal's movement bounces off surfaces, and the whiskers respond by bending slightly, signaling the presence of an obstacle. Whiskers also vibrate slightly as they touch a surface, transmitting information about the shape and texture of a surface or object.
Have you ever seen whiskers quiver? The specialized hairs are highly mobile. Cats and dogs can extend their whiskers out to the side and pull them back against the face. They extend them forward to determine where to place the killing bite when holding prey or to find and pick up items with the mouth.
Most whiskers are long and straight, but some cat breeds with unusual fur also have unusual whiskers, like Devon Rex and Cornish Rex cats, which often have short kinked or curly whiskers.
See Also: Why Do Dogs and Cats Have Tails?

Whisker Care Never trim or pull out whiskers. The nerves at their roots are highly sensitive, and it can be uncomfortable for the animal to have them trimmed. Just say no if a groomer wants to trim them to neaten the face.
While there's no scientific evidence that longer whiskers are better than short ones, I know from being a veterinarian for more than 30 years that clients who have cats with loooong whiskers love it when I say how much I love them. I have to believe that for some cats (and maybe dogs), having long whiskers is like having giant antlers. There just has to be some kind of "whisker envy" going on.

 http://shine.yahoo.com

ND bishop exposes churchgoers to hepatitis A

By JAMES MacPHERSON 13 hours ago

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FILE - This undated file photo provided by the Catholic Diocese of Fargo, N.D., shows John Thomas Folda, …

BISMARCK, N.D. (AP) — The bishop of the Fargo Catholic Diocese exposed some parishioners at North Dakota churches in Fargo, Grand Forks and Jamestown to the hepatitis A virus in late September and early October.
The state Health Department on Thursday issued an advisory of exposure for anyone who attended any of the five affected churches and took communion from Bishop John Folda, 52. State immunization program manager Molly Howell said that the risk is low but that officials "felt it was important for people to know about the possible exposure."
State health officials say they are not sure exactly how many churchgoers might have been exposed. A church official from one affected church said about 25 people there received communion from Folda.
Diocese spokeswoman Aliceyn Magelky told The Associated Press that Folda contracted the liver disease from contaminated food while attending a conference last month in Italy for newly ordained bishops. Folda has taken time off work since Oct. 10 due to the virus, she said.
"He's doing great," Magelky said of Folda. "He's moving back into his regular schedule."
Folda issued a statement Friday apologizing to parishioners.
"I sincerely apologize to the people who may have been exposed to the virus," his statement said. "I wish I had known I was ill so I could immediately refrain from participating in public activities. Unfortunately, I had no symptoms immediately following my return and during the events that have been brought to the public's attention."
Folda attended and participated in communion distribution at the Sept. 27 school Mass at Holy Spirit Church in Fargo; the 10:30 a.m. Mass on Sept. 29 at St. Michael's Catholic Church in Grand Forks; the Sept. 29-Oct. 2 priest convention at St. James Basilica in Jamestown; the Oct. 6 noon Mass at Cathedral of St. Mary in Fargo; and the Oct. 7 Mass at St. Paul's Catholic Newman Center in Fargo.
Hepatitis A is rarely deadly but can cause serious liver problems.
Folda said his doctor has told him that he is no longer contagious and hasn't been for some time.
Magelky on Friday said Folda would soon be able to perform communion "whatever time he is invited to or asked."
Clay Whittlesey, who serves communion at a Catholic church in Fargo, said people take great care with hygiene when preparing the bread or wafers and wine.
"I have talked to a lot of people about this, and nobody is too worried about contracting hepatitis A," he said. "Mostly we're praying for a healthy and speedy recovery for the bishop."
Magelky said priests in the diocese were notified on Monday of Folda's illness. She said the diocese did not notify the state Health Department of Folda's illness.
"It wasn't something that was required," Magelky said.
Howell, of the health department, said doctors in North Dakota are required to report hepatitis cases. She said the agency learned of the illness from a "case investigation," though she would not provide specifics, citing privacy issues.
Howell said health officials learned of the bishop's illness too late to urge people to get a hepatitis A vaccination as a precautionary measure. A vaccination can prevent illness if given within two weeks of exposure.
"The two-week time period had passed," she said. "It was too late."
Symptoms of the liver disease include fever, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, pale stools or jaundice. Symptoms can take 15 to 50 days to appear. People who develop symptoms are urged to consult a doctor. Howell said health officials do not recommend that people get tested if they do not have symptoms.
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Associated Press writer Dave Kolpack contributed to this report from Fargo, N.D.

Satellite spots light show in the middle of the ocean

By Mike Krumboltz, Yahoo News 18 hours ago The Sideshow

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Those weird lights in the middle of the Atlantic Ocean — what are they?

Are they an unstoppable force of electric underwater creatures swimming, slowly but steadily, toward the shore where they will flood our cities and force us all to watch "Finding Nemo" from now until the end of time?

Fortunately, no (for now). The lights, which were spotted using Visible Infrared Imaging Radiometer Suite on the Suomi NPP satellite, are actually a large collection of fishermen.

NASA explains, "There are no human settlements there, nor fires or gas wells. But there are an awful lot of fishing boats."

Yep, that's right, those lights that could easily be mistaken for a series of heavily populated islands are actually powerful lights on boats.

What exactly are the fishermen looking for? And why are they out blasting their high beams?

From NASA:

The night fishermen are hunting for Illex argentinus, a species of short-finned squid that forms the second largest squid fishery on the planet. The squid are found tens to hundreds of kilometers offshore from roughly Rio de Janeiro to Tierra del Fuego (22 to 54 degrees South latitude). They live 80 to 600 meters (250 to 2,000 feet) below the surface, feeding on shrimp, crabs, and fish. In turn, Illex are consumed by larger finfish, whales, seals, sea birds, penguins ... and humans.

Fishermen use the powerful lights, "generating as much as 300 kilowatts of light per boat," to draw the plankton and fish that the squid eat toward the surface. The squid then follow the food. Alas, it's the last meal for many.

Baby's HIV 'cure not a fluke,' US researchers say

By Kerry Sheridan October 24, 2013 4:33 AM

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A premature newborn lies on a cot in the neo-natal ward of the Delafontaine hospital in Saint Denis near Paris on March 19, 2013. (AFP Photo/Joel Saget)

Washington (AFP) - A little girl who was treated for HIV shortly after birth still shows no sign of infection at age three, suggesting her apparent cure was not a fluke, US researchers said.
The story of the first child known to have been cured of HIV through early treatment with powerful doses of antiretroviral drugs -- what researchers call "sustained remission" rather than a cure -- was initially announced in March when she was two and a half.
A handful of HIV-infected adults around the world have been described in medical literature as newly free of the disease, most famously Timothy Brown, also known as "the Berlin patient," who was given a bone marrow transplant for leukemia that wiped out his HIV as well.
But no easy method has emerged to eradicate the three-decade-old human immunodeficiency virus that infects 34 million people globally and is responsible for 1.8 million deaths each year.
The girl's updated case report in the New England Journal of Medicine also sought to answer questions raised by outside experts over whether she was ever really infected, by describing DNA and RNA tests that were positive for HIV just over a day after birth.
The child was given antiretroviral drugs until the age of age 18 months and, after a year and half without treatment, no sign of the disease has returned, the article said.
"Our findings suggest that this child's remission is not a mere fluke but the likely result of aggressive and very early therapy that may have prevented the virus from taking a hold in the child's immune cells," said lead author Deborah Persaud, a virologist and pediatric HIV expert at the Johns Hopkins Children's Center on Wednesday.
The child's mother gave birth to her prematurely, about a month early, and had not received any prenatal care. She was unaware that she was HIV positive until she was tested at the Mississippi hospital where she delivered.
The newborn also tested positive for HIV, and the high level found in her blood suggested that she had become infected with human immunodeficiency virus while in the womb, researchers said.
She also showed signs of HIV in blood tests at 19 days of age, data that "support the authors' perspective that the infant was truly infected," said an accompanying editorial by Scott Hammer, a leading HIV scientists at Columbia University Medical Center.
"The big question, of course, is, 'Is the child cured of HIV infection?' The best answer at this moment is a definitive 'maybe,'" he wrote.
A longer term follow up of the child is needed, he said, cautioning that her case may be "unique," even as it shows a proof of principle that may lead to more rigorous studies down the road.
The child was given antiretroviral drugs for the first 15-18 months of her life, when she was lost to follow up.
Her mother brought her back to doctors at 23 months of age, saying she had last given her anti-HIV medication at age 18 months.
"This happened almost by accident," said Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases.
"It wasn't that the doctor said 'let's stop the therapy.' This is not recommended for home use," he told AFP.
Tests at 23 months were negative for HIV, and by the time the child reached 30 months of age, tests still showed no sign of HIV or HIV antibodies, said the study.
"We're thrilled that the child remains off medication and has no detectable virus replicating," said pediatrician Hannah Gay of the University of Mississippi Medical Center.
"We've continued to follow the child, obviously, and she continues to do very well," said Gay, who first treated her.
"There is no sign of the return of HIV, and we will continue to follow her for the long term."
The girl's medical team believes the reason for her success was the early intervention, and they hope to investigate whether treating other infected infants within hours or days of birth could show similar outcomes.
A US-government funded study is set to begin in low and middle income countries in 2014 that would test the method in HIV-infected newborns on a wider scale, Fauci said.

Surfer with boxing skills fights off attacking shark

Jeff Horton says he landed about eight blows in persuading large predator to back off; board now has a crescent-shaped bite, an inch deep

October 23, 2013 by Pete Thomas

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Jeff Horton’s surfboard, with visible bite marks, is now a souvenir. Photo by Neil Edmands

A surfer on the Hawaiian island of Kauai claims to have used boxing skills to fend off an attacking shark that bit into his board, narrowly missing his leg.
Jeff Horton (pictured at right) was surfing earlier this week at Pila’a Beach near Kilauea. He told the Garden Island that he saw the shark, presumably a tiger shark, swimming toward him as he sat on his board.
“It came flying straight toward me,” he said.
Upon impact, Horton rolled off of his board and onto the shark, which he briefly rode before unleashing a barrage of punches.
“I started punching as hard as I could,” he said, adding that he landed about eight blows and caused the shark to back off with a knuckle punch to the eye.
Horton said he used to be a boxer, and that he was just reacting instinctively.
“I was pretty scared,” he said.
There were about 10 others in the water, watching the chaotic incident, and many others on the beach, 200 yards away.
Horton managed to climb back onto his board and paddle ashore. Aside from abrasions on his hands, he was not injured. The surfboard is left with a crescent-shaped bite mark, an inch deep.

Tiger shark photo is generic. Courtesy of Wikipedia

Horton told the Garden Island that he was greeted with a group hug on the beach, and that a tourist gave him $50 and told him to go celebrate.
The surfer presumably complied, and said he’ll be hanging the board on his wall as a souvenir.
Will Horton continue to paddle out on another board?
“I’ll surf the rest of my life,” he said.

Prehistoric-looking alligator snapping turtle is not wanted in Oregon

'Dinosaur of the turtle world,' discovered by an angler, is the first of these invasive critters to be found in the state, and hopefully the last

October 23, 2013 by Pete Thomas

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Biologist Jason Journey poses with invasive alligator snapping turtle captured at Prineville Reservoir. Credit for all images: Oregon Department of Fish and Wildlife

A fisherman at Prineville Reservoir in Oregon was startled last Friday to spot a large, prehistoric-looking creature cruising along the surface.
Wildlife experts were notified and the next day the creature, an exotic alligator snapping turtle, was captured and euthanized. (Rick Boatner of the Oregon Department of Wildlife explained that it could not be relocated because of disease issues that could threaten other populations. He added that “their large size, aggressive behavior and very long life span makes them difficult to place.”)
This week there’s concern about the possibility that others of its kind are in Prineville—or elsewhere in Oregon. This is the first known find of what’s sometimes referred to as “the dinosaur of the turtle world” in Oregon, and hopefully the last.

Close-up of the alligator snapping turtle

Why?
Because alligator snapping turtles, with their scaly tails, spiked shells, and powerful beaked jaws, do not belong anywhere but their native southeastern United States habitat (where they’re a threatened species). There, in swamps and river and canals, they help balance the ecosystem.
Beyond that territory, though, they’re regarded as pests with the potential to adversely impact native fishes, amphibians, and small ducks. They also can spread disease to native species, and their powerful bite makes them somewhat dangerous to humans.
Moreover, the alligator snapping turtle is the largest freshwater turtle in the United States. It can weigh at least 220 pounds and an unverified report from Kansas, in 1937, placed the weight of one specimen at 403 pounds.
How the much smaller alligator snapping turtle made it into Prineville Reservoir is anyone’s guess, but it’s believed that it was released by someone who had owned the critter as a pet, and released it when it became too large to care for.
Its shell will be used as part of an educational display of invasive, or non-native species, according to the Idaho Statesman Journal.
“We already have problems in the Willamette Valley with common snapping turtles,” said Rick Boatner, a biologist with the Oregon Department of Fish and Wildlife. “I’d hate to see these turtles get established in Oregon.”

Rising drug resistance threatens global progress against TB

By Kate Kelland October 23, 2013 5:21 AM

A patient with tuberculosis sits on a bed in "Tuberculosis Village," a separate health facility at a …

By Kate Kelland
LONDON (Reuters) - Cases of people infected with tuberculosis and the number of deaths from it fell in 2012, but progress on controlling the contagious lung disease is under threat from growing drug resistance.
In its annual report on tuberculosis, the World Health Organisation said the world was on track to meet U.N. goals for 2015 of reversing TB incidence and cutting the death rate by 50 percent compared to 1990.
Yet around 3 million people with TB are being missed by health systems, and "superbug" drug-resistant strains of the bacterial infection are putting progress at risk.
"Far too many people are still missing out on care and are suffering as a result," said Mario Raviglione, the WHO's director of the Global TB Programme.
"They are not diagnosed, or not treated, or information on the quality of care they receive is unknown."
TB is often seen as a disease of the past, but the emergence over the past decade of strains that can not be treated with existing drugs has turned it into one of the world's most pressing health problems.
Of all infectious diseases, only HIV - the human immunodeficiency virus that causes AIDS - kills more people than TB.
In 2012, an estimated 8.6 million people developed TB and 1.3 million died from the disease, including 320,000 deaths among HIV-positive people, according to Wednesday's WHO report, down from 8.7 million cases and 1.4 million deaths in 2011.
Raviglione said insufficient resources for TB were at the centre of all the hurdles to further progress. The WHO says $7 to $8 billion a year is needed for a full response to the global TB epidemic by 2015, and there is a funding shortfall of some $2 billion a year.
WEAK LINKS
Many TB programmes do not have the capacity to find and care for people in hard-to-reach groups - such as the homeless, the poor, and the marginalised, who often live outside any formal or state health system.
Weak links in what health experts call the "TB chain" -connecting proper detection and diagnoses to quality treatment and care - lead to people in these groups being missed.
The WHO estimates that 75 percent of the 3 million missed TB cases are in just 12 countries, with South Africa, Bangladesh, India and Pakistan among them.
On the issue of multi-drug resistant TB (MDR-TB), the WHO report said the problem was not only that the links in the chain were weak, but that links were not even there.
The U.N. health agency estimates that 450,000 people fell ill with MDR-TB in 2012 alone, with China, India and Russia worst affected, followed by another 24 other countries.
More worrying, around 16,000 MDR-TB cases reported to WHO in 2012 were not put on treatment, with long waiting lists becoming a increasing problem.
Raviglione said it was unacceptable that increased rates of diagnosis were not matched by more access to MDR-TB care.
"We have patients diagnosed but not enough drug supplies or trained people to treat them," he said.
Grania Brigden, a TB adviser for the international medical charity Medecins Sans Frontieres, said the failure to improve rates of diagnosis and treatment for drug-resistant TB is being paid for in lives.
"The horrific scale of preventable suffering and death caused by the spiralling drug resistant TB crisis must spur governments, donors and WHO to mobilise the political will and secure the funding ... to tackle this deadly epidemic head on," she said.
The WHO's report is based on data from a total of 197 countries and territories that collectively have more than 99 percent of the world's TB cases.

Cholera Outbreak Gripping Mexico, 171 Confirmed Cases

October 21, 2013

Image Credit: Thinkstock.com

 

Lawrence LeBlond for redOrbit.com – Your Universe Online
Last month, Mexico was affected by a hurricane and tropical storm that dumped heavy rain on the region, causing floods, landslides and displacement of large numbers of people. Health experts noted that the disaster may have contributed to the growing number of cholera cases that are now also affecting the region, which first became evident around the second week of September.
Mexico’s Ministry of Health has reported a total of 171 cases of infection with cholera to the World Health Organization (WHO) between Sept 9 and Oct 18, 2013.
Of the confirmed cases of cholera, the largest outbreak has occurred in the state of Hidalgo, accounting for 157 cases. An additional nine cases have occurred in the state of Mexico. Two cases have been reported from the Federal District, as well as two from the state of Veracruz. A single case has also been reported in the state of San Luis Potosi.
Cholera infection has occurred in 86 women and 85 men, with ages ranging from three months to 88 years old. A total of 39 cases have resulted in hospitalization and there has been one death linked to the infection.
Health authorities in Mexico continue to investigate the outbreak, stepping up surveillance methods at a national level and working to ensure that quality care is available at medical units throughout the region. Experts are training health professionals on how best to handle the outbreak, with information on prevention, treatment and control of the disease.
Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. The infection is known to cause watery diarrhea and volatile vomiting. Transmission of the bacteria occurs primarily by drinking water or eating food that has been contaminated by the feces of infected persons. In severe cases hospitalization is required. Severe cholera can lead to dehydration and electrolyte imbalance and, in rare cases, death can occur if not treated.
Primary treatment of cholera consists of oral rehydration therapy with a typical rehydration solution to help replace vital nutrients lost during illness. If oral rehydration is not tolerated or does not provide relief quickly enough, intravenous methods are used. In some cases, antibacterial medicines are used to shorten the duration and severity of the illness.
Cholera affects upwards of five million people each year around the world and has caused between 100,000 and 130,000 deaths annually since 2010.
In Mexico, the Ministry of Health said that treatment of cholera is continuing and currently eight in 10 cases are treated successfully. The Ministry said another 3,075 “probable cases” have also been detected, according to a Reuters report last week.
The source of the outbreak is believed to be the Rio Tecoluco in Hidalgo, which has recently tested positive for cholera. The Rio Tecoluco provides fresh water to local residents, David Korenfeld, head of Mexico’s national water commission, told Reuters.
According to the WHO report, this is the first local transmission of cholera recorded since the 1991-2001 cholera epidemic in Mexico. Genetic analysis of the bacterium obtained from patients in the current outbreak presents a 95 percent similarity with the strain that is currently circulating in three Caribbean countries (Haiti, Dominican Republic and Cuba). The current strain is different from the strain that caused the 1991-2001 epidemic in Mexico.
Based on current information, the WHO does not recommend any travel or trade restrictions with Mexico in respect to this outbreak.

Source: Lawrence LeBlond for redOrbit.com - Your Universe Online 

 

 

1854 Broad Street cholera outbreak

From Wikipedia, the free encyclopedia

Broadwick Street showing the John Snow memorial and public house.

The Broad Street cholera outbreak was a severe outbreak of cholera that occurred near Broad Street (now renamed Broadwick Street) in Soho district of London, England in 1854. This outbreak is best known for the physician John Snow's study of the outbreak and his discovery that cholera is spread by contaminated water. This discovery came to influence public health and the construction of improved sanitation facilities beginning in the 19th century.

Contents

• 1 Background
• 2 Outbreak
• 3 John Snow investigation
• 4 Henry Whitehead involvement
• 5 See also
• 6 References
• 7 External links

Background

In the mid-19th century, the Soho district of London had a serious problem with filth due to the large influx of people and a lack of proper sanitary services: the London sewer system had not reached Soho. Many cellars (basements) had cesspools of night soil underneath their floorboards. Since the cesspools were overrunning, the London government decided to dump the waste into the River Thames. This action contaminated the water supply, leading to the cholera outbreak.

Outbreak

On 31 August 1854, after several other outbreaks had occurred elsewhere in the city, a major outbreak of cholera struck Soho. John Snow, the physician who eventually linked the outbreak to contaminated water, later called it "the most terrible outbreak of cholera which ever occurred in this kingdom."^[1]
Over the next three days, 127 people on or near Broad Street died. In the next week, three quarters of the residents had fled the area. By 10 September, 500 people had died and the mortality rate was 12.8 percent in some parts of the city. By the end of the outbreak, 616 people had died.

John Snow investigation

Original map by John Snow showing the clusters of cholera cases in the London epidemic of 1854. The pump is located at the intersection of Broad Street and Cambridge Street.

Snow was a skeptic of the then-dominant miasma theory that stated that diseases such as cholera or the Black Death were caused by pollution or a noxious form of "bad air". The germ theory was not created at this point (as Louis Pasteur would not create it until 1861), so Snow was unaware of the mechanism by which the disease was transmitted, but evidence led him to believe that it was not due to breathing foul air. He first publicized his theory in an essay On the Mode of Communication of Cholera in 1849. In 1855 a second edition was published, with a much more elaborate investigation of the effect of the water-supply in the Soho, London epidemic of 1854.
By talking to local residents (with the help of Reverend Henry Whitehead), he identified the source of the outbreak as the public water pump on Broad Street (now Broadwick Street).^[2] Although Snow's chemical and microscope examination of a sample of the Broad Street pump water was not able to conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to disable the well pump by removing its handle. Although this action has been popularly reported as ending the outbreak, the epidemic may have already been in rapid decline, as explained by Snow himself:

There is no doubt that the mortality was much diminished, as I said before, by the flight of the population, which commenced soon after the outbreak; but the attacks had so far diminished before the use of the water was stopped, that it is impossible to decide whether the well still contained the cholera poison in an active state, or whether, from some cause, the water had become free from it.

Snow later used a spot map to illustrate how cases of cholera were centred around the pump. He also made a solid use of statistics to illustrate the connection between the quality of the source of water and cholera cases. Snow's efforts to connect the incidence of cholera with potential geographic sources centered on creating what is now known as a Voronoi diagram. He mapped out the locations of individual water pumps and generated cells which represented all the points on his map which were closest to each pump. The section of Snow's map representing areas in the city where the closest available source of water was the Broad Street pump circumscribed most cases of cholera.^[3]
There was one significant anomaly - none of the monks in the adjacent monastery contracted cholera. Investigation showed that this was not an anomaly, but further evidence, for they drank only beer, which they brewed themselves.
Snow also showed that the Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted sections of the Thames and delivering the water to homes with an increased incidence of cholera. Snow's study was a major event in the history of public health and health geography, and can be regarded as the founding event of the science of epidemiology.
In Snow's own words:

On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the [Broad Street] pump. There were only ten deaths in houses situated decidedly nearer to another street-pump. In five of these cases the families of the deceased persons informed me that they always sent to the pump in Broad Street, as they preferred the water to that of the pumps which were nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street...
With regard to the deaths occurring in the locality belonging to the pump, there were 61 instances in which I was informed that the deceased persons used to drink the pump water from Broad Street, either constantly or occasionally...
The result of the inquiry, then, is, that there has been no particular outbreak or prevalence of cholera in this part of London except among the persons who were in the habit of drinking the water of the above-mentioned pump well.
I had an interview with the Board of Guardians of St James's parish, on the evening of the 7th inst [September 7], and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.

—John Snow, letter to the editor of the Medical Times and Gazette

It was discovered later that this public well had been dug only three feet from an old cesspit that had begun to leak fecal bacteria. A baby who had contracted cholera from another source had its nappies (diapers) washed into this cesspit, the opening of which was under a nearby house that had been rebuilt farther away after a fire had destroyed the previous structure, and the street was widened by the city. It was common at the time to have a cesspit under most homes. Most families tried to have their raw sewage collected and dumped in the Thames to prevent their cesspit from filling faster than the sewage could decompose into the soil.
After the cholera epidemic had subsided, government officials replaced the Broad Street Pump Handle. They had responded only to the urgent threat posed to the population, and afterward they rejected Snow's theory. To accept his proposal would have meant indirectly accepting the oral-fecal method transmission of disease, which was too unpleasant for most of the public to contemplate.^[4]

Henry Whitehead involvement

Rev. Henry Whitehead

The Reverend Henry Whitehead was an assistant curate at St. Luke's church in Soho, London, during the 1854 cholera outbreak.
A former believer in the miasma theory of disease, Whitehead played to disprove false theories, eventually focusing on John Snow's idea that cholera spreads through water contaminated by human waste. Snow's work, particularly his maps of the Soho area cholera victims, convinced Whitehead that the Broad Street pump was the source of the local infections. Whitehead then joined with Snow in tracking the contamination to a faulty cesspool and the outbreak's index case.^[5]
Whitehead's work with Snow combined demographic study with scientific observation, setting important precedent for the burgeoning science of epidemiology. ^[6]

See also

• Filippo Pacini
• Great Stink
• Joseph Bazalgette
• William Budd
• Epidemiology of tuberculosis
• The Ghost Map

Cholera outbreaks and pandemics

From Wikipedia, the free encyclopedia

Hand bill from the New York City Board of Health, 1832. The outdated public health advice demonstrates the lack of understanding of the diseases and its actual causative factors.

Although much is known about the mechanisms behind the spread of cholera, this has not led to a full understanding of what makes cholera outbreaks happen some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread. Bodies of water have been found to serve as a reservoir, and seafood shipped long distances can spread the disease. Cholera did not occur in the Americas for most of the 20th century after the early 1900s in New York City. It reappeared in the Caribbean toward the end of that century and seems likely to persist.^[1]
Deaths in India between 1817 and 1860, in the first three pandemics of the nineteenth century, are estimated to have exceeded 15 million people. Another 23 million died between 1865 and 1917, during the next three pandemics. Cholera deaths in the Russian Empire during a similar time period exceeded 2 million.^[2]

Contents

• 1 Pandemics
  • 1.1 First
  • 1.2 Second
  • 1.3 Third
  • 1.4 Fourth
  • 1.5 Fifth
  • 1.6 Sixth
  • 1.7 Seventh
• 2 Notable outbreaks (1991–2009)
• 3 Notable outbreaks (2010–present)
• 4 False reports
• 5 See also
• 6 References

Pandemics

First

• 1816–1826: The first cholera pandemic, though previously restricted, began in Bengal, and then spread across India by 1820. Hundreds of thousands of Indians and ten thousand British troops died during this pandemic.^[3] The cholera outbreak extended as far as China, Indonesia (where more than 100,000 people succumbed on the island of Java alone) and the Caspian Sea in Europe, before receding.

Second

• 1829–1851: A second cholera pandemic reached Russia (see Cholera Riots), Hungary (about 100,000 deaths) and Germany in 1831; it killed 150,000 people in Egypt that year.^[4] In 1832 it reached London and the United Kingdom (where more than 55,000 people died)^[5] and Paris. In London, the disease claimed 6,536 victims and came to be known as "King Cholera"; in Paris, 20,000 died (of a population of 650,000), and total deaths in France amounted to 7,000.^[6] The epidemic reached Quebec, Ontario and New York in the same year, and the Pacific coast of North America by 1834. In the center of the country, it spread through the cities linked by the rivers and steamboat traffic.^[7]

In 1846, cholera struck Mecca, killing over 15,000 people.^[8] A two-year outbreak began in England and Wales in 1848, and claimed 52,000 lives.^[9]
In 1849, a second major outbreak occurred in Paris. In London, it was the worst outbreak in the city's history, claiming 14,137 lives, over twice as many as the 1832 outbreak. Cholera hit Ireland in 1849 and killed many of the Irish Famine survivors, already weakened by starvation and fever.^[10]Template:Needs better source In 1849, cholera claimed 5,308 lives in the major port city of Liverpool, England, an embarkation point for immigrants to North America, and 1,834 in Hull, England.^[6]
An outbreak in North America took the life of former U.S. President James K. Polk. Cholera, believed spread from Irish immigrant ship(s) from England, spread throughout the Mississippi river system, killing over 4,500 in St. Louis^[6] and over 3,000 in New Orleans.^[6] Thousands died in New York, a major destination for Irish immigrants.^[6] Cholera claimed 200,000 victims in Mexico.^[11]
That year, cholera was transmitted along the California, Mormon and Oregon Trails as 6,000 to 12,000^[12] are believed to have died on their way to the California Gold Rush, Utah and Oregon in the cholera years of 1849–1855.^[6] It is believed more than 150,000 Americans died during the two pandemics between 1832 and 1849.^[13][14]
In 1851, a ship coming from Cuba carried the disease to Gran Canaria. It is considered that more than 6,000 people died in the island during summer, out of a population of 80,000.
During this pandemic, the scientific community varied in its beliefs about the causes of cholera. In France doctors believed cholera was associated with the poverty of certain communities or poor environment. Russians believed the disease was contagious, although doctors did not understand how it spread. The United States believed that cholera was brought by recent immigrants, specifically the Irish, and epidemiologists understand they were carrying disease from British ports. Lastly, some British thought the disease might rise from divine intervention.^[15]

Third

• 1852–1860: The third cholera pandemic mainly affected Russia, with over one million deaths. In 1852, cholera spread east to Indonesia, and later was carried to China and Japan in 1854. The Philippines were infected in 1858 and Korea in 1859. In 1859, an outbreak in Bengal contributed to transmission of the disease by travelers and troops to Iran, Iraq, Arabia and Russia.^[8] Japan suffered at least seven major outbreaks of cholera between 1858 and 1902. The Ansei outbreak of 1858-60, for example, is believed to have killed between 100,000 and 200,000 people in Tokyo alone.^[16]

1854: An outbreak of cholera in Chicago took the lives of 5.5% of the population (about 3,500 people).^[6][17] In 1853–4, London's epidemic claimed 10,738 lives. The Soho outbreak in London ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle.^[18] His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. It would take many years for this message to be believed and acted upon. Throughout Spain, cholera caused more than 236,000 deaths in 1854–55.^[19] In 1854 and 1855, it entered Venezuela; Brazil also suffered in 1855.^[11] During the third pandemic, Tunisia, which had not been affected by the two previous pandemics, thought Europeans had brought the disease. They blamed their sanitation practices. Some United States scientists began to believe that cholera was somehow associated with African Americans, as the disease was prevalent in the South in areas of black populations. Current researchers note their populations were underserved in terms of sanitation infrastructure, and health care, and they lived near the waterways by which travelers and ships carried the disease.^[20]

Fourth

The following text needs to be harmonized with text in Fourth cholera pandemic (1863–75).

• 1863–1875: The fourth cholera pandemic spread mostly in Europe and Africa. At least 30,000 of the 90,000 Mecca pilgrims died from the disease. Cholera ravaged northern Africa in 1865. Traveling southeastward, cholera reached Zanzibar, where 70,000 people are reported to have died in 1869–70.^[21] Cholera claimed 90,000 lives in Russia in 1866.^[22] The epidemic of cholera that spread with the Austro-Prussian War (1866) is estimated to have taken 165,000 lives in the Austrian Empire.^[23] Hungary and Belgium each lost 30,000 people, and in the Netherlands, 20,000 perished. In 1867, Italy lost 113,000 lives.^[24] That same year, cholera traveled to Algeria and killed 80,000.^[21]

1892 cholera outbreak in Hamburg, hospital ward

1892 cholera outbreak in Hamburg, disinfection team

Outbreaks in North America in 1866–1873 killed some 50,000 Americans.^[13]

In London,^[when?] a localized epidemic in the East End claimed 5,596 lives, just as the city was completing construction of its major sewage and water treatment systems (see London sewerage system); the East End section was not quite complete. William Farr, using the work of John Snow, et al., as to contaminated drinking water being the likely source of the disease, relatively quickly identified the East London Water Company as the source of the contaminated water. Quick action prevented further deaths.^[6] Also, a minor outbreak occurred at Ystalyfera in South Wales, caused by the local water works using contaminated canal water. Workers associated with the company and their families were most affected, and 119 died. In the same year, more than 21,000 people died in Amsterdam, The Netherlands. In the 1870s, cholera spread in the U.S. as an epidemic from New Orleans along the Mississippi River and to ports on its tributaries; thousands of people died.

Fifth

• 1881–1896: The fifth cholera pandemic, according to Dr A. J. Wall, the 1883–1887 part of the epidemic cost 250,000 lives in Europe and at least 50,000 in the Americas. Cholera claimed 267,890 lives in Russia (1892);^[25] 120,000 in Spain;^[26] 90,000 in Japan and over 60,000 in Persia.^[25] In Egypt, cholera claimed more than 58,000 lives. The 1892 outbreak in Hamburg killed 8,600 people. Although the city government was generally held responsible for the virulence of the epidemic, it went largely unchanged. This was the last serious European cholera outbreak, as cities improved their sanitation and water systems.

Sixth

• 1899–1923: The sixth cholera pandemic had little effect in western Europe because of advances in public health, but major Russian cities and the Ottoman Empire were particularly hard hit by cholera deaths. More than 500,000 people died in the Russian Empire of cholera during the first quarter of the 20th century, which was also a time of social disruption because of revolution and warfare.^[27]

The 1902–1904 cholera epidemic claimed 200,000 lives in the Philippines.^[28] Twenty-seven epidemics were recorded among pilgrims to Mecca from the 19th century to 1930, and more than 20,000 pilgrims died of cholera during the 1907–08 hajj.^[27] The sixth pandemic killed more than 800,000 in India.
The last outbreak in the United States was in 1910–1911, when the steamship Moltke brought infected people from Naples to New York City. Vigilant health authorities isolated the infected in quarantine on Swinburne Island. Eleven people died, including a health care worker at the hospital on the island.^[29][30][31]

In this time period, because immigrants and travelers often carried cholera from infected locales, the disease became associated with outsiders in each society. The Italians blamed the Jews and gypsies, the British who were in India accused the “dirty natives”, and the Americans saw the problem coming from the Philippines.^[32]

Seventh

• 1961–1975: The seventh cholera pandemic began in Indonesia, called El Tor^[33] after the strain, and reached East Pakistan (now Bangladesh) in 1963, India in 1964, and the Soviet Union in 1966. From North Africa, it spread into Italy by 1973. In the late 1970s, there were small outbreaks in Japan and in the South Pacific. There were also many reports of a cholera outbreak near Baku in 1972, but information about it was suppressed in the USSR.^{[citation needed]} In 1970, a cholera outbreak struck Sağmalcılar district of Istanbul, then an impoverished slum, claiming more than 50 lives; eventually the incident led to the renaming of the district as present-day Bayrampaşa by the authorities who were harshly criticized.

Notable outbreaks (1991–2009)

• January 1991 – September 1994: Outbreak in South America, apparently initiated when a ship discharged ballast water. Beginning in Peru,^[34] there were 1.04 million identified cases and almost 10,000 deaths. The causative agent was an O1, El Tor strain, with small differences from the seventh pandemic strain. In 1992 a new strain appeared in Asia, a non-O1, nonagglutinable vibrio (NAG), which was named O139 Bengal. It was first identified in Tamil Nadu, India and for a while displaced El Tor in southern Asia. It decreased in prevalence from 1995 to around 10% of all cases. It is considered to be an intermediate between El Tor and the classic strain, and occurs in a new serogroup. Scientists warn of evidence of wide-spectrum resistance by cholera bacteria to drugs such as trimethoprim, sulfamethoxazole and streptomycin.

• A persistent strain of Gulf Coast cholera, 01, has been found in the brackish waters of marshes in Louisiana and Texas in the United States, leading to a situation of possible transmission by shipments of seafood from those areas to other parts of the country. Medical personnel were advised to think of cholera when assessing symptoms for people who had not been traveling. There have been occurrences in the South but no major outbreaks because of good sanitation and warning systems. It was noted there were more cases in two years from the Latin American epidemic, the El Tor strain, than in 20 years from the Gulf Coast strain.^[35]

• In 2000, some 140,000 cholera cases were officially reported to WHO. Countries in Africa accounted for 87% of these cases.^[36]

• July–December 2007: A lack of clean drinking water in Iraq led to an outbreak of cholera.^[37][38] As of 2 December 2007, the UN had reported 22 deaths and 4,569 laboratory-confirmed cases.^[39]

• August 2007: The cholera epidemic started in Orissa, India. The outbreak affected Rayagada, Koraput and Kalahandi districts, where more than 2,000 people were admitted to hospitals.^[40]

• March–April 2008: 2,490 people from 20 provinces throughout Vietnam were hospitalized with acute diarrhea. Of those hospitalized, 377 patients tested positive for cholera.^[41]

• August–October 2008: As of 29 October 2008, a total of 644 laboratory-confirmed cholera cases, including eight deaths, had been verified in Iraq.^[42]

• November 2008: Médecins Sans Frontières reported an outbreak of cholera in a refugee camp in the Democratic Republic of the Congo's eastern provincial capital of Goma.^[43] Some 45 cases were reportedly treated between November 7 and 9.

By 12 February 2009, the number of cases of infection by cholera in sub-Saharan Africa had reached 128,548 and the number of fatalities, 4,053.

• January 2009: The Mpumalanga province of South Africa confirmed over 381 new cases of Cholera, bringing the total number of cases treated since November 2008 to 2276. Nineteen people died in the province since the outbreak.^[44]

• August 2008 – April 2009: In the 2008 Zimbabwean cholera outbreak, which continued into 2009, an estimated 96,591 people in the country were infected with cholera and, by 16 April 2009, 4,201 deaths had been reported.^[45][46] According to the World Health Organization, during the week of 22–28 March 2009, the "Crude Case Fatality Ratio (CFR)" had dropped from 4.2% to 3.7%.^[45] The daily updates for the period 29 March 2009 to 7 April 2009, list 1748 cases and 64 fatalities, giving a weekly CFR of 3.66% (see table above).^[47] Those for the period 8 April to 16 April list 1375 new cases and 62 deaths (and a resulting CFR of 4.5%).^[47] The CFR had remained above 4.7% for most of January and early February 2009.^[48]

Notable outbreaks (2010–present)

• August 2010: Cholera in Nigeria was reaching epidemic proportions after widespread confirmation of the disease outbreaks in 12 of its 36 states. 6400 cases have been reported with 352 reported deaths. The health ministry blamed the outbreak on heavy seasonal rainfall and poor sanitation.^[49]

• October 2010 - January 2012, Haiti and Dominican Republic: Late in October 2010, a cholera outbreak was reported in Haiti.^[50] As of November 16, the Haitian Health Ministry reported the number of dead to be 1,034, with hospitalizations for cholera symptoms totaling over 16,700.^[51] The outbreak was blamed on a camp of Nepalese United Nations peacekeepers, but this was disputed. Scientists have found that Vibrio cholera bacteria can survive between outbreaks in brackish warm water, and it exists in Haitian waterways. The outbreak started on the upper Artibonite River.;^[52] people first contracted the disease from this river.^[53] In addition, scientists think the hurricane and weather conditions in Haiti worsened the consequences of the outbreak, and damaged sanitation systems allowed it to spread.^[52] In the USA, a Florida woman who had recently moved from Haiti had cholera but was effectively treated. Officials noted that US water systems removed the risk of transmission by water supply.^[54] By November 2010, the disease had spread into the neighboring Dominican Republic. As of January 2012, the epidemic has sickened nearly 500,000 people and killed nearly 7,000 in Haiti.^[55]

• In January 2011, about 411 Venezuelan citizens attended a wedding in the Dominican Republic, where they ate ceviche (raw fish cooked in lemon juice) at the celebration. By the time they returned to Caracas and other Venezuelan cities, some of these travelers were suffering from symptoms of cholera. By January 28, almost 111 cases had been confirmed by the Venezuelan Health Authorities, who quickly set up an 800 number for people to call who wondered whether they were infected. Internationally, Colombia secured its eastern border against immigrants and probable transmission of the disease. Dominican officials started a nationwide study to determine the cause of the outbreak, and warned residents of the imminent danger associated with the consumption of raw fish and shellfish. As of January 29, 2011, none of the cases in Venezuela proved fatal, but two patients were hospitalized. Since the victims had quickly sought help, the outbreak was detected and contained.^[56]

• 2011: Nigeria and Democratic Republic of Congo have had outbreaks; the latter has suffered years of disruption from warfare. Somalia has suffered a double hit of cholera and famine, associated with the refugee camps, limited sanitation, and severe drought causing famine and lowered resistance.^[57]

• Cholera has returned to southern India in 2012, once thought to be eradicated, in relatively affluent Kerala, ironically, due to efforts to improve sanitation, toilets were constructed. While these toilets were under construction, workers defecated and contaminated community wells, causing the outbreak.^[58]

• Cholera outbreak in 2011 and 2012 in multiple African nations, in all regions except North Africa, among them Ghana has led to intense campaign for handwashing.^[59] In Sierra Leone, some 21,500 cases with 290 deaths have been reported in 2012.^[60]

• Since 2010, fatal cholera outbreaks, not just travelers, have been reported in Haiti, Dominican Republic, Cuba, Venezuela, Iraq, Nepal, Pakistan, Iran, Bangladesh, Myanmar, Laos, Cambodia, Vietnam, Afghanistan, India, China, Nigeria, Sierra Leone, Kenya, Uganda, Zimbabwe, Zambia, Angola, Somalia, Ethiopia, Ivory Coast, DRC, Congo, Mozambique, Ghana, Guinea, Mali, Ukraine, and Niger.

• On August 21, 2013 the United States State Department issued a security message warning U.S. citizens in or traveling to Cuba about an outbreak of cholera in Havana, that may be linked to a reported outbreak of cholera in eastern Cuba.^[61]

False reports

Main article: Chicago 1885 cholera epidemic myth

A persistent urban myth states 90,000 people died in Chicago of cholera and typhoid fever in 1885, but this story has no factual basis.^[62] In 1885, a torrential rainstorm flushed the Chicago River and its attendant pollutants into Lake Michigan far enough that the city's water supply was contaminated. But, as cholera was not present in the city, there were no cholera-related deaths. As a result of the pollution, the city made changes to improve its treatment of sewage and avoid similar events.

See also

• List of epidemics