Alexandra Levitt's Deadly Outbreaks: An Expert Tour of Epidemiology (including aerosolized pig brains)

Reading the tales of infectious disease outbreak investigations is, to me, the equivalent of opening up Sherlock Holmes' case book and seeing a master unravel a case. The delight I get in reading books like that keeps me coming back to read each new infectious disease book with wide eyes, trying to glean whatever I can from the particular outbreak being described. 

Such was my reaction to Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses, and Drug-Resistant Parasites by the CDC's Alexandra Levitt. The book is a compendium of important outbreak investigations over the past few decades that are illustrative of the power of epidemiology in elucidating causes, avoiding blind alleys, and changing policy.

Some of the included topics are: the original Legionnaire's Disease outbreak, the Four Corners Hantavirus outbreak, a multi-drug resistant malaria scare in Cambodian refugee populations, and the fascinating non-infectious pig-brain inhalation neurologic autoimmune syndrome. Being in the field of infectious disease, an added bonus for me was to read about people I know and interact with doing the investigative work.

I highly recommend the book for a concrete glimpse of what epidemiology is and how big its impact can be. Plus, who wouldn't want to read about aerosolized pig brains? 

I am a Dirty Contact Lens Wearer

I've had contact lenses for over 20 years and I can remember distinctly the first time I placed them in my eyes and how frustrating that process was. It got to the point where I threw a full tantrum when I couldn't get the contact lens to adhere to my eye.

Now it is second nature and I can do it in a car, in an elevator, or wherever I might be when one happens to fall out. I have even moistened a lens with tap water and even with saliva. It is easy to forget that your eye is a special tissue that is not nearly as resilient as one's skin and is a rather simple place for a microbe to flourish, especially when aided by prosthetic material (i.e., a contact lens) let alone poor hygiene.

None of this is good, especially not for an infectious disease physician. So, it comes as no surprise that I am not alone amongst contact lens users. Like my fellow dirty eye people, I have had numerous episodes of conjunctivitis and have had to take antibiotic eye drops and steroids several times--sometimes self-prescribed or prescribed by mom or dad. 

Thankfully my game of Russian Roulette with my contact lenses hasn't resulted in corneal ulcerations or a severe amoebic infection...yet. 

If You're Going to Say Something, Make it Matter

Carly Fiorina was the CEO of a major technology company whose products aimed to improve human life. In that role she was an advocate of innovation and technological process. While most people think of electronic devices and space technologies as synonymous with innovation, vaccines are indisputably on par with such conventional examples as they have transformed the life of the average human tremendously. Indeed, most advances in public health from sanitation to disease detection are the result of technological advances.

Accordingly, I was shocked to see Ms. Fiorina countenance the positions of those who seek to endanger children by prohibiting vaccination against diseases that remain clear and present dangers in this country.

While it has become commonplace to hear politicians and public figures of all political persuasions make statements that cast unwarranted doubt on vaccines, it is inexcusable for someone of Ms. Fiorina's stature and she knows it (and Governor George Pataki correctly pointed out). Hence, her nuanced position which affirms the rights of school operators to exclude the unvaccinated.

Further when Ms. Fiorina references esoteric vaccines it is clever trick that allows her to play both sides of the issue. When I hear that term "esoteric vaccines" the vaccines against yellow fever, Japanese Encephalitis, smallpox, and anthrax spring to mind. However, my context is radically different from that of the average voter she is attempting to court who may erroneously think of the vaccines against human papilloma virus, hepatitis B, and chickenpox as "esoteric."

It should be an asset to a candidate to be pro-technology and all embracing of a tool that has literally added decades to the lives of all humans, not something that requires spin. It is never a good thing pander to the primitive to be a viable candidate.

It is only through an intransigent defense of vaccines that all vaccine-preventable diseases will become esoteric.

The NYC Subway: Plague & Anthrax, but not Urine, Free

I often tell people that bacteria are everywhere, because they are. They lurk in almost every niche of the planet, including all the niches in and on our bodies. Some are found in more abundance in certain environments such as fresh water, salt water, on reptiles, in the soil, etc. 

So, when a study reported all the myriad microbes found in the NYC subway, I wasn't surprised as it as a perfect Petri dish for many different microbes because many people traverse it, it is littered with discarded food and often has puddles of liquid (which could be rain water on a good day, urine or some other substance on a bad day). Plus, rodents abound. 

The controversial part of the study, which detailed many different microbes being present, was the researchers detection of the bacteria that cause plague and anthrax in the subway. Such a finding immediately grabbed headlines. I also didn't find this to be too surprising because it is well known that both Bacillus anthracis and Yersinia pestis are widely distributed in the enviroment--though Y.pestis tends to stay west of the "plague line".  

The study was back in the headlines earlier this week when the research time clarified their findings, which now exclude the detection of the plague and anthrax bacilli in the subway. 

I would caution people--and rats--to not breath too deep a sigh of relief in the subway as, though not at risk for plague or anthrax, the smell of urine might do you in. 

Rumbling with Legionnaire's Disease in the Bronx

The attention rightly given the Bronx Legionnaire's Disease outbreak is interesting to me as a Pittsburgher where Legionella pneumophilia is in the water, quite literally. Almost monthly a Pittsburgh news outlet reports of Legionella being found in a water source, including those fountains at shopping malls and parks. We recently experienced a deadly Legionnaire's Disease outbreak that evolved into a full-fledged scandal at the Pittsburgh VA hospital that even President Obama took note of.

The important points to keep in mind about Legionnaire's Disease are:

• It is nothing new. Legionnaire's Disease was first described in 1976 and retrospectively tied to earlier outbreaks. 
• Legionella bacteria are a natural inhabitant of water--even rain puddles--where they live within amoeba.
• Legionnaire's Disease is quite common, comprising up to 5% of ordinary community-acquired pneumonias. It tends to infect older individuals with other medical conditions and is not communicable between people.
• Hugh Hefner had to think about it!

The Bronx outbreak underscores the need to think about water sources for buildings and whether they have been adequately maintained and disinfected at regular intervals, if not this is what occurs. The trajectory of the current NYC outbreak--there is a separate cluster at West Chester University in Pennsylvania--will likely end as cases are diagnosed and the common source water is treated. 

Infectious diseases are legion and Legionnaire's Disease is just another member of the pack that is easily tamed.