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Cynomolgus monkey, a known reservoir of the Monkeypox virus

In recent months, the mpox virus (formerly monkeypox) has become a major health crisis globally. The outbreak started small but now exploded to over 15,600 cases and 537 deaths as of August 2024 in the Democratic Republic of the Congo (DRC). This rapid increase is largely due to a new deadly strain, Clade 1b, which emerged last year in the country.

This strain of the mpox virus is spreading rapidly, mainly through sexual networks. It has now reached African countries like Burundi, Kenya, Rwanda, and Uganda for the first time. The virus also spread to Europe, with Sweden reporting its first case.

Responding to the crisis, the World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern (PHEIC) on August 14, 2024. This declaration highlights the serious nature of the spread and the potential for even more unreported cases. It’s a call to the international community to join forces and help contain the virus, supporting affected countries in managing this escalating threat.

While it’s important not to panic, it is helpful to stay aware of the symptoms, diagnosis, treatment, and ways to prevent the infectious disease.

What is mpox (formerly monkeypox)?

Mpox is an infectious disease caused by the mpox virus. The virus belongs to the same family as the smallpox virus. The disease was originally named monkeypox after it was first detected in lab monkeys in 1958. In 2022, WHO renamed the infectious disease to ‘mpox’, to align with modern guidelines and eliminate “racist and stigmatizing language” associated with the name.

The first human case of mpox was not discovered until 1970 in the Democratic Republic of Congo [2]. The virus belongs to the Orthopoxvirus genus of the Poxviridae family and is an enveloped double-stranded DNA virus. Other members of poxviridae include smallpox (variola), cowpox, buffalopox, and aracatuba [2].

This 1997 image was created during an investigation into an outbreak in the Democratic Republic of the Congo (DRC) and depicts the palms of an mpox case-patient. It is important to note how similar this maculopapular rash appears to be compared to the rash of smallpox, also an Orthopoxvirus. Image courtesy of CDC/Dr. Brian W.J.Mahy

How do you get mpox? How does it spread?

According to WHO, the mpox virus can spread from person to person through various ways, including:

• By talking or breathing close to an infected person
• Skin-to-skin contact
• Mouth-to-mouth transmission (like kissing)
• Oral sex or kissing skin
• Droplets in the air from close contact for a prolonged period.

Notable outbreaks

2024

• As of August 2024, the WHO has reported over 15,600 Mpox cases and 537 deaths in the DRC. This is a significant increase compared to the total numbers for all of 2023.
• Just hours after the WHO declared mpox as an emergency, the Swedish government confirmed their first case of the dangerous mpox variant, clade 1b. The affected individual was infected in Africa.

2023

• Between January-December, 2023, there were 92,783 lab-confirmed cases of mpox reported globally.
• 14, 626 cases and 654 deaths were in the DRC alone.

Among these cases, 581 resulted in suspected mpox-related deaths, reflecting a case fatality ratio of 4.6%. According to WHO, this is the highest number of cases ever recorded. Even more worrying is that several cases have been reported in regions that had not previously reported mpox cases.

2022

From January 1 to September 13, 2022, 4,494 cases of mpox (171 fatal) were reported in the Democratic Republic of Congo.

Cases in the Democratic Republic of Congo, 1970 – 2019

Notable mpox outbreaks in the past

• During the single year of 1967, almost eleven thousand cases occurred in West and Central Africa.
• The most unusual disease outbreak of mpox occurred in 2003 when 81 humans in the American Midwest were infected through contact with infected prairie dogs – themselves infected by rodents imported from Ghana. Fortunately, all patients recovered and did not face longer-term effects of the infection.
• From 2018 to 2019, five Nigerian travelers were found to have mpox – in Israel, Singapore, and London.

Who is at risk of getting infected?

Mpox is endemic to Central and West Africa, which puts people in these regions at higher risk of getting mpox.

Other vulnerable people include:

• Those with compromised or weak immune systems
• Children under one year old  (However, the 2024 mpox outbreaks shows a higher proportion of infections in children below 15 years)
• People with a history of eczema
• People who are pregnant
• Men who have sex with men (MSM).

Symptoms

According to the US CDC, mpox symptoms usually appear within 3-17 days after a person is first infected (incubation period).

Mpox symptoms start with:

• Fever 
• Headache
• Muscle pain and backache
• Swollen lymph nodes
• Chills 
• Extreme tiredness
• Sore throat, cough, or other respiratory issues.

A characteristic rash develops after a few days (1-4). Note: Infected persons can spread the virus 1-4 days before symptoms appear, making it even more important to get tested early if you suspect an infection.

Diagnosis

Mpox symptoms can be confused with that of chickenpox and smallpox, but a distinguishing feature of mpox is the presence of swelling in the lymph nodes.

Differential diagnosis must include other rash-related illnesses like scabies, skin infections, and syphilis. The most common diagnostic tool is a physical examination by trained physicians and the PCR (polymerase chain reaction).

However, for this test to provide accurate results, samples from skin lesions or fluid from the rash vesicles or pustules work best. PCR blood tests for mpox, and antigen and antibody tests are usually inconclusive, according to WHO. 

Treatment

Mpox often goes away on its own within 2-4 weeks so treatment for mpox usually focuses on alleviating symptoms and taking care of the rash.

There are no therapies specifically designed to treat mpox but outbreaks can be controlled with drugs (antivirals) and the mpox vaccine which can be given within 4 days of contact with an infected person. If there are no symptoms, the mpox vaccine can be given up to 14 days.  [7]. 

Prevention

A person who is infected with mpox can help prevent the spread of the disease by staying at home and isolating from others, washing hands often with soap, cover the rashes when around others (but can otherwise leave them open to dry and heal), do not share bedlinen, towels, or other items until fully recovered, and take regular over-the-counter pain medication to help ease symptoms.

There are two mpox vaccines currently approved for use by WHO. However, the global organization is requesting vaccine manufacturers to ramp up production of the mpox vaccine to help during this public health emergency.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Alkhurma, Botulism, Cryptococcus, etc. Or check out our global status updates on countries like Algeria, Canada, Iceland, and more! 

Already a subscriber?

Learn more about mpox (formerly monkeypox) on the GIDEON platform.

References

[1]  “Multi-country monkeypox outbreak in non-endemic countries,” Who.int. [Online] [Accessed: 26-May-2022].

[2]   H. Adler et al., “Clinical features and management of human monkeypox: a retrospective observational study in the UK,” Lancet Infect. Dis., 2022.

[3]   “Monkeypox,” Cdc.gov, 20-May-2022. [Online] [Accessed: 26-May-2022].

[4]  “Monkeypox,” nhs.uk. [Online][Accessed: 26-May-2022].

[5]   Z. Jezek, M. Szczeniowski, K. M. Paluku, M. Mutombo, and B. Grab, “Human monkeypox: confusion with chickenpox,” Acta Trop., vol. 45, no. 4, pp. 297–307, 1988.

[6]  “Monkeypox,” Who.int. [Online][Accessed: 26-May-2022].

[7]   “Monkeypox,” Cleveland Clinic. [Online][Accessed: 26-May-2022].

[8]    P. Joi, “How the smallpox vaccine stockpile could stop monkeypox in its tracks,” Gavi.org, 24-May-2022. [Online][Accessed: 26-May-2022].

2018. Sklenovská and M. Van Ranst, “Emergence of Monkeypox as the most important Orthopoxvirus infection in humans,” Front. Public Health, vol. 6, p. 241, 2018.

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Caused by bacteria, tuberculosis is highly contagious and potentially deadly. It spreads quickly from person to person through the air when someone sneezes or coughs, making it hard to contain. In fact, just one person can spread TB to more than 15 people at a time when in close contact. While it’s a significant public health risk and can be prevented and treated, it does not get the attention it deserves.

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Understanding the ins and outs of norovirus is crucial to reduce the risk of getting infected and minimize its disruptive effects on public health. In this guide, we delve into all you need to know about norovirus, including the history, epidemiology, transmission, symptoms, diagnosis, treatment, and preventive methods. 

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Lyme disease is spread through the bite of deer ticks (Ixodes scapularis ticks)and is caused by the bacterium Borrelia burgdorferi. If Lyme disease is left untreated, it can be dangerous and affect various organs, including the skin, joints, heart, and even the nervous system.

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The news brings much-needed hope to regions dealing with malaria outbreaks, but other areas may also feel its positive impact. With climate change and globalization, mosq1uito-borne illnesses have been spreading to non-endemic regions as well. An effective mass vaccination campaign can help prevent outbreaks and interrupt transmission world over.

There’s no doubt that the malaria mass vaccination campaign will stand on the shoulders of successful programs prior. Let’s take a look at three such notable mass immunization campaigns through the years, starting with the recent COVID-19 vaccines. Read more on our blog: https://www.gideononline.com/blog/.

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Join us as we explore common infectious diseases and better understand how pathogens cause infections and how we can advance the fight against infectious diseases. Visit us at https://www.gideononline.com/blog/ to learn more. 

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When biofilms form on medical devices and catheters in our bodies, they can cause severe infections that are hard to treat. This is because bacteria in them are protected by the slimy biofilm matrix, which makes it harder for antibiotics to do their job.

According to the US National Institutes of Health, biofilms are responsible for over 80% of microbial infections in the body. Many of these are resistant to antibiotics and may even cause severe chronic infections.  Apart from the toll on the nation’s health, this type of resistance can get expensive. Learn more on our blog: https://www.gideononline.com/

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As an example, imagine you eat a lovely salad, but a few hours later, find yourself violently sick. You may have gotten food poisoning from a bacteria in the salad. When this type of infection happens to a few more people, public health agencies trace how the infection spreads through a community. This is a standard process in infection control. And breaking the chain can prevent more large-scale outbreaks.

Mapping the chain of infection for a pathogen can help us learn how an infection spreads. This knowledge helps us develop effective strategies to break the chain and reduce the spread of disease. Learn more on our blog: https://www.gideononline.com/blog/

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The good news is that Rinderpest is the first animal disease to be eradicated. However, during its time, it was highly contagious and caused severe economic disruptions. Sometimes, entire herds of cattle were wiped out after contracting Rinderpest.

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About 89,000 people die from melioidosis each year. Although there’s concern about its potential for bioterrorism, the risk of getting sick for the general population is relatively low—only 1 in 4600 exposures lead to disease. Learn more in our blog: https://www.gideononline.com/blog

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Each year, in the United States, UTIs contribute to over 10 million office visits, surpass 2 million emergency department visits, and result in 100,000 hospitalizations. As a result, estimated costs linked to these infections in the US range from $1 billion to $1.6 billion annually, including both direct and indirect expenses.

Around 40% of women are estimated to have experienced a UTI at some stage in their lives. Although sexually active young women bear a higher burden, other people are also susceptible to these infections. These include the elderly, individuals undergoing surgery on their urinary tracts, and those who get catheters inserted. Learn more on our blog: https://www.gideononline.com/blog

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After all, it is the compass that guides your entire research process – from data gathering and analysis to reporting and publishing.

What are Good Research Questions?

Good research questions must:

 – identify a relevant issue in your field,

 – pursue relatively unchartered research territories to address the problem, and

 – pique the interest of your professors and peers.

It may seem overwhelming at first, but following a step-by-step approach, like the one outlined below, can help.

Here’s How to Write a Good Research Question in 5 Steps.

• Step 1: Pick a topic of interest
• Step 2: Find your different perspective
• Step 3: Check access to relevant research
• Step 4: Write a strong research question
• Step 5: Validate your research question

Step 1: Pick Broad Topics For Your Question

If you can pick any topic you like, select a topic that you care about. Even if you do not have complete freedom to choose your topic, evaluate certain aspects or problems within the area that interest you.

For example, suppose you want to write about an emerging infectious disease. You could pick:

• a specific pathogen to write about,
• a novel way to treat the disease,
• the potential for a vaccine, or
• study the epidemiology of outbreaks worldwide or region-specific.

If you are interested in data science, you could evaluate different models and compare how effective they are in predicting the spread or progression of a disease. This can be helpful in developing research questions.

Do not worry about finalizing topics at this stage. Pick two (or three) topics to explore further.

Step 2: Find a Different Perspective for Your Study

A good research question needs to offer a unique perspective, approach, or insight into a topic.

However, finding the right research topic is a balancing act.

If a topic is already well-researched, it may be harder to differentiate and find an ‘unknown’ for you to address. On the other hand, if a topic is heavily under-researched, you may have difficulty finding the data you need.

Once you have your potential research topic areas (from step1), review journals and periodicals to evaluate:

• What research already exists on your topic?
• What are the controversies and hotly debated issues surrounding your topic?
• What areas do the latest research (in the past five years) focus on?

Pro Tip for Inspiration:  Pay attention to the discussion section in journal articles to identify unsolved issues in your field. Focus on well-written, well-cited articles in peer-reviewed publications. Authors often list challenges they faced during their research and discuss issues in the field that remain unaddressed.

Step 3: Check Your Access to Relevant Research, Data, and Journals

You will need to rely on pre-existing primary and secondary research in your field for your work.

Make sure you verify if your library or department:

• is subscribed to journals relevant to your topic,
• can provide you access to required databases for your analysis, and
• offers the analytical or simulation software you need.

For example, what if you want to learn if recent dengue outbreaks may turn into the next pandemic? Apart from publications, you need access to a comprehensive epidemiology database like GIDEON, the World Health Organization (WHO), or others. Depending on the type of study, you may also need access to technology for advanced statistical analysis, creating spatial or heat maps, and specific types of charts.

Step 4: Writing Out Your Potential Questions

There are 5 research question types:

– Exploration: These are research questions that want to understand more about a certain topic or a higher-level topic.

– Predictive: As the name suggests, these types of research questions attempt to interpret historical trends or user survey responses to predict future events or outcomes.

– Interpretive: This type of research observes behavior in a group of study subjects or a natural phenomenon as it exists without introducing any change. 

– Comparative: Comparative studies compare the differences in one or more groups performing against a specific set of variables.

– Relationship-based: A group of variables that are related to each other or influence each other in one or more ways, can be studied using a relationship-based research question [1].

These can be grouped into 3 categories – qualitative research questions, quantitative research questions, and mixed-method research questions.

How to Write a Quantitative Question

A quantitative research question is, as the term suggests, one that attempts to answer a problem with a quantitative solution. Studies that answer these are often data-driven and often involve statistical analytics.

These research questions attempt to analyze and offer measurable results like:

 1) How much? How often? What percentage or proportion?

 2) What is the difference between one or more groups? 

 3) How does one variable affect or correlate with another? You are often evaluating the relationship between two or more variables.

How to Write a Qualitative Question

Qualitative research questions often do not have one clear answer. Their answers and research methods will be more descriptive. You will be debating, weighing, and analyzing various complex issues.

Remember, your research topic may be complex, but your research question must be concise, focused, and clear.

Qualitative research questions should be:

• Concise and clear,
• Specific and objective, not generic and open-ended, and 
• Focused on answering a particular problem through a well-argued discussion.

So, take a look at the research question examples listed here.

Note: If you have a longer thesis or dissertation, especially for school, you may have to find your overarching research question first, and break it down.  

A mixed-method, the third type of research question, uses both quantitative and qualitative data to address specific issues. This type of process is used to discuss more complex research questions and often in new and emerging fields of research where there are several unknowns.

Step 5: Validate It

By the time most students get to step 5, you are exhausted from the effort of finding the right research question. This is why it is essential not to skip this step.

Run your research question and any other questions you are considering by your research mentor, knowledgeable peer or seniors, or others in the field to get their thoughts. You can also ask someone who is not in your field of research for a fresh, outside perspective. Constructing research questions doesn’t always have to be a solo job and sometimes your peers will have at least one example for you to emulate. Gathering information is one of the most important things you can do when starting research and brainstorming questions.

Now, here are some examples of good and bad research questions. It may be helpful to use these as a working example for writing questions of your own especially if you are still learning. Another tip if you are new to writing a research question, you will often find that schools and professors may recommend trying “If… Then…” statements.

Write This, Not That

Bad: How many countries have lymphatic filariasis infections?

Good: How much have the incidence and prevalence rates of lymphatic filariasis changed across Southeast Asia in the past decade, and why?

Great: How have lymphatic filariasis control programs in Southeast Asia affected prevalence rates in the last decade?

Analysis: The first research question example is too simple. The answer can be found in another research study or epidemiological database like GIDEON in the blink of an eye. A good research question, like the example above, works because you are analyzing and reporting trends across various countries in a region. Additionally, you are providing insight into why changes have occurred over a specific timeframe of a decade. The great research question example helps the audience understand the ‘so what’ or relevance of your research. In this instance, you are not only analyzing trends but tying them to what people are most concerned about when it comes to infectious diseases – what worked and what didn’t. It is okay to focus a study and your questions on information that is considered trending for your field of study.

***

Bad: Is hypertension dangerous? Or Why is hypertension dangerous?

Good: How does hypertension affect blood sugar levels?

Great: What is the effect of untreated hypertension on adults with type 2 diabetes mellitus?

Analysis: The bad research question is too generic. The topic for the good research question example is current and relevant – there is considerable research into the factors affecting type 2 diabetics. The prevalence of both health conditions, hypertension, and type 2 diabetes is on the rise. This warrants more investigation. However, the research question is still relatively open-ended. The great example question narrows down the problem of the unchecked increase in blood pressure levels in a specific group of people – adults with type 2 diabetes.

***

Bad: How to stop the next pandemic?

Good: What were the most significant factors that turned a COVID-19 outbreak into a pandemic?

Great: How effective were U.S. policies in preventing the spread of COVID-19 (SARS-CoV-2) and its variants from March 2020- to August 2021?

Analysis: The bad research question is too generic and open-ended. The research question that is a good example is related to the COVID-19 pandemic, which is a specific and current topic of interest globally. However, the great example of a research question dives down into a specific country’s COVID-19 policies during a relevant time period. As part of your background research, you will research the significant factors that helped COVID-19 turn from an outbreak to a pandemic and offer insight into what worked and what didn’t.  

***

Bad: Will the next pandemic be dengue?

Good: In what ways are recent dengue outbreaks a potential to be the next pandemic?

Great: In what ways do recent Dengue outbreaks in new regions indicate a high risk to become the next pandemic?

Analysis: The first example of a research question can be answered with a yes or no. It is also more like the attention-grabbing title from a news outlet. The good research question works because it states that there are recent dengue outbreaks, making the topic relevant and specific. Also, the question asks if a trend or pattern is connecting these outbreaks to a more widespread disaster. There is much scope for analysis and discussion. The great question adds more relevancy and urgency to the research. It talks about the fact that dengue outbreaks have spread to new regions. This makes it a cause for concern and could be a sign of a future pandemic.

 ***

Finding the right research question is often iterative. So, do not worry if you begin your research and find that you need to make changes. If you plan to submit your research to a journal or publication, please follow their rules and guidelines.

Use GIDEON for Public Health Research.

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools- GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Diseases in Search of Etiology, Antimicrobial Agents,  Medically Important Yeasts and Algae, and more. Or check out our global status updates on countries like Grenada, Kuwait, Liberia, Malta, and more!

References

The post Writing Great Research Questions: How To Find the Best Questions For Your Research Study appeared first on GIDEON.

Epidemiologists, you can now get your data insights faster with the Quantify tool – one of the most cutting-edge additions to the comprehensive infectious disease database. Many people may not realize that an epidemiologist’s work is like that of a swan. Swans may glide smoothly on a lake, but their elegance is fueled by furious and relentless pedaling under the water. Similarly, readers can peruse infectious disease journals quickly with a simple online search. However, these publications are the culmination of years, and even decades, of extensive and meticulous data collection and analytics.

The Quantify module is a handy resource for busy epidemiologists in all research areas. It is applicable whether you study the epidemiology of emerging infectious diseases, disease surveillance in Africa, hepatitis C infections worldwide, the impact of lymphatic filariasis in Asia or pertussis vaccination efforts in France, and much more. It allows users to explore epidemic data, disease diagrams, disease frequency, and outbreak data.

Quantify Runs on The Popular GIDEON Epidemiology Database

With the Quantify module, you and your research teams can customize over 38,000 individual graphs on disease prevalence, prevalence rates, mortality, and vaccine coverage (when applicable). This means less time cleaning, organizing, and validating and more time for higher-level understanding.

Quantify draws from the robust GIDEON infectious disease database for deeper epidemiological insights. With 838,000+ data points across 235 countries and territories, the GIDEON database covers over 360 infectious diseases. All GIDEON charts feature a modern aesthetic that helps elevate the look and feel of your final submission. Additionally, since the database is updated daily, it is easy to refresh your data right before your presentation or paper submission.

How to Compare and Visualize Epidemiological Trends From Health Data Using GIDEON’s Quantify?

The Quantify module makes it easy for you to compare spatiotemporal datasets worldwide. For example, to demonstrate the measurable success of Wild Polio eradication efforts, you can generate a chart showing the decline in cases worldwide. Quantify can generate this for you in one step.

Image: Wild Poliomyelitis cases worldwide from 1996 to 2020. 

As another example, what if you want a chart comparing Dengue deaths in India, Indonesia, and Malaysia?

Image: Dengue deaths in India, Indonesia, and Malaysia. 

Here’s how easy it is to create this custom epidemiological graph using Quantify:

Step 1: Select the disease

Step 2: Add the countries you wish to compare. You have the option to see worldwide data.

Step 3: Select the type of chart you need – prevalence, prevalence rates (per 100,000 population), deaths, or vaccine coverage.

Image: 3 easy steps to create custom epidemiology charts using the Quantify tool. 

Simplify Your Disease or Population Research with Quantify

Would you like to learn how GIDEON Informatics and the Quantify tool can help you optimize your epidemiology research?

Book a demo with us to get started! GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Lassa and Lujo Fevers, Legionellosis, Mansonelliasis, and more. Or check out our global status updates on countries like Guam, Kyrgyzstan, Libya, Mauritania, and more!

The post Custom Epidemiological Charts: Quick Insights on Prevalence, Mortality, and More appeared first on GIDEON.

Image: Microbiologist testing poultry sample for the presence of Salmonella

About 150 children in Finland and a total of 450 individuals have fallen ill from Salmonella poisoning. Most affected individuals are from daycare centers in the city of Jyväskylä. The cause of this outbreak is suspected to be lettuce imported from Germany via Sweden [1]. Though Salmonella outbreaks have been declining, the 2021 Finland outbreak is one of many reported worldwide this year. As our world continues to shrink due to globalization, it is getting harder for public health agencies to monitor and prevent Salmonella outbreaks from imported foods. 

This year, Sweden has also reported a national Salmonella outbreak that affected more than 30 people [2]. In June, melons sourced from Costa Rica, Honduras, or Brazil were the most likely cause of a Salmonella outbreak of 200 people across ten countries, including Finland, Denmark, Belgium, Germany, the Netherlands, Sweden, United Kingdom, Canada, and Switzerland [3]. In the United States, the CDC (Centers for Disease Control and Prevention) initiated a ‘Food Safety Alert’ after detecting 102 infected cases across 14 states due to contaminated seafood that originated in Colorado [4]. 

One of the biggest challenges in catching a Salmonella infection is the fact that the bacteria is mainly found in fresh produce and other foods with a short shelf life such as raw foods. This hurdle is made even more complex because of the popular hub-and-spoke model of centralized food distribution and food systems. In this model, one country in a region acts as a centralized hub that processes fresh produce,  raw meat, or poultry. This food is then exported to several countries simultaneously. By the time infections are reported, most of the contaminated inventory may have already been consumed – either on its own or mixed with other batches – or thrown away. This makes it difficult to obtain enough samples to test and trace the country of origin [5]. 

So we know in current times, food such as raw food plays a large role in foodborne infection development, especially in those with weakened immune systems. The questions that remain are: should those with a healthy immune system need to worry, what is the history behind the illness, and what symptoms can those experiencing these types of infections expect?

A History of Salmonellosis in Finland

Let’s take a closer look at Finland. At 9.29 cases per 100,000 population, Finland has the highest rate among Nordic countries despite its stringent controls and processes [6]. 

Image: Salmonellosis rates per 100,000 population for Finland, Sweden, Norway, Iceland, and Denmark.

Before 2021, the biggest Salmonella outbreak in Finland was in 2008. Pre-chopped and ready-to-eat Iceberg lettuce happened to be the prime suspect for the 2008 Salmonella infection outbreak in Finland. There were 77 confirmed cases, and two elderly patients died [7]. 

Image: Salmonellosis in Finland. Cases from 1969 to 2021.

Finland has seen a steady decline since 1995 when the country initiated its national Salmonella control program. The Finnish national Salmonella control program (FSCP) mandates regular testing of cattle, poultry, and pigs, including eggs and raw meat. Lab test results are evaluated by the Finnish Food Agency monthly. There are stringent checks and balances included throughout their entire supply chain. 

The FSCP measures have helped lower the rates of homegrown Salmonella infections. However, like many other countries, Finland needs a faster and more effective way to monitor and prevent the bacteria from being brought in from other countries, either through travel or cross-border food imports [8]. 

List of Prominent Salmonella outbreaks in Finland*: 

• 1976: 550 cases were reported due to contaminated mayonnaise prepared in Spain and served on four international flights (Las Palmas-Helsinki, Las Palmas-Honover). 
• 1986: 226 cases from packaged meals offered to train and air passengers. 

• 1992: 224 cases due to contaminated mung beans.

• 1994: 210 cases in Southern Finland due to alfalfa seeds.

• 1995: 242 cases were reported in Finland (and the U.S.) due to alfalfa seeds imported from a Dutch supplier. 

• 2001 – 2003: 666 cases reported in Norway, Finland, and Swedish tourists infected by contaminated poultry.

• • • 2001: 303 cases
    • 2002: 164 cases
    • 2003: 199 cases.

• 2007: 8,453 cases (almost 30% of the population) due to contaminated water in the town of Nokia, Finland. It is the largest reported water-borne outbreak in Finland [9].   

• 2008: 107 cases in Newport and Reading, Finland due to contaminated lettuce. 

• 2015: 122 cases in Finland due to an ice hockey team event in Latvia.

• 2021: 450 cases due to contaminated lettuce imported from Germany via Sweden. 

*Data sourced from GIDEON. GIDEON also has case count maps.

Public health agencies worldwide continue to worry about keeping cases down in their respective countries. But in this hyper-connected world, it can prove challenging. A comprehensive database such as GIDEON that tracks outbreaks as they happen across the world may be a viable solution. 

Image: Salmonella outbreaks worldwide and list of Salmonella outbreaks in Finland. 

What Is It and What Are the Symptoms? 

Salmonellosis is the infection acquired from ingesting the zoonotic bacteria Salmonella. The most common way to get it is by eating raw or undercooked meat, eggs, or fruit and vegetables that have not been washed and handled correctly. 

The illness is highly contagious, and you can get sick from any person, animal, or thing that carries the Salmonella bacteria, even if you are healthy. The bacteria are transmitted to our mouths from contaminated human or animal feces fecal-oral transmission). Other risk factors for Salmonella poisoning are travel to high-risk countries with poor sanitation and exposure to birds and reptiles being kept as pets. 

Symptoms include: 

• Diarrhea
• Stomach cramps or pain
• Fever

The symptoms usually last four to seven days and begin within 12 to 72 hours of consuming the contaminated food [10]. If you happen to be experiencing symptoms that are incredibly severe, it is not a bad idea to head to a hospital or doctor for treatment. There are medicine options for those with this type of infection.

Image: a woman experiencing stomach cramps

How is It diagnosed?

Here is where local laboratory test results play a significant role in helping curb the spread of Salmonella. Usually, stool or blood samples are used to test for Salmonella. Once detected, many countries have protocols that require these labs to report positive incidences of Salmonella to approved public health laboratories for serotyping and DNA fingerprinting.

Around the world, we can also enable on-ground clinicians to play a stronger role in identifying Salmonella cases early and preventing its spread. Having access to data on outbreaks as they happen can help public health officials detect the origin of infection much sooner and more effectively.  It can make all the difference in the field of medicine to have all the information and facts in advance.

How Does Modern Medicine and Medical Practice Prevent Salmonellosis? 

Good immunity and remaining healthy are the best line of defense against Salmonella. Our natural stomach acid can help fight Salmonellosis. However, there is a greater risk of infection for those with impaired immune functioning due to: 

• the overuse of antacids, 
• effects of antibiotics, 
• age – infants and the elderly, 
• pregnant women, and 
• lowered immunity from chronic illnesses like Irritable Bowel Syndrome (IBS) and other conditions like AIDS, Malarial infections, and more. 

Other ways to minimize the risk of getting Salmonella is to:

• always wash your hands before you eat, after touching animals, using the toilet, or changing diapers,  
• clean food preparation areas, and 
• minimize the intake of raw and uncooked food like eggs and meat. If fresh produce is to be consumed raw, then it must be washed thoroughly. 

Note: Foods containing Salmonella do not smell or look different from uncontaminated food. Washing hands and following food safety guidelines is your best bet to mitigate risk.   

Use GIDEON for Public Health and Microbiology Research

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Latin American Arboviruses, Melioidosis and Glanders, Necrotizing Soft Tissue Infections, and more. Or check out our global status updates on countries like Guinea Bissau, Liechtenstein, Mauritius, New Caledonia, and more!

References 

The post Salmonella by Any Other Name: Salmonellosis in Finland & How to Prevent the Next Outbreak appeared first on GIDEON.

Image: Newborn Aedes albopictus mosquito

More Than Tropical Illnesses

Aedes aegypti and Aedes albopictus mosquito-borne illnesses are not just tropical diseases anymore

There’s Dengue fever in California and reports of Zika, Dengue, and Chikungunya cases in Florida. West Nile cases are on the rise in the US, with two recent deaths reported in Arizona and Los Angeles. What do they have in common? These diseases are all mosquito-borne diseases transmitted by the Aedes aegypti and Aedes albopictus species of mosquitoes.

The Aedes aegypti mosquito can transmit Dengue, Yellow fever, Zika, Chikungunya, West Nile Virus, and Venezuelan Equine Encephalitis Virus. Aedes albopictus can transmit Dengue, Chikungunya, Yellow fever, West Nile, Zika, Japanese encephalitis, and more.

These cases have been high enough to warrant different states taking action to curb the spread of the disease. The first genetically modified mosquitoes were released in Florida early this year, designed to suppress the Aedes aegypti mosquito.

Image: Dengue rates in the United States, 1930 to 2020. 

Is the spread of infectious disease mosquitoes to non-tropical countries a recent phenomenon? How are epidemiologists and infectious disease specialists monitoring and predicting the spread and risk? How will the introduction of the Aedes family of mosquitoes affect the population of other species of mosquitoes? How exactly are the viruses maintained in the mosquitoes?

GIDEON Informatics partnered with virologist Dr. Melissa K. Jones at the University of Florida to investigate. Dr. Jones recently moderated an informative webinar on the invasion of the Aedes mosquitoes in the United States, particularly Florida. Experts on the panel were:

• Guy Hendrickx: Co-founder AVIA-GIS, a Belgian organization focused on spatial mapping and modeling of various topics, including infectious diseases.
• Stephen Berger MD: experienced practicing physician, infectious diseases specialist, and co-founder of GIDEON, the comprehensive infectious disease database.

Highlights From the Webinar

Drs. Hendrickx, Berger, and Jones had a fascinating conversation about Aedes-borne diseases. They began by discussing the spread of the Aedes family of mosquitoes away from its traditional habitat in South and Southeast Asia.

Spread of Aedes Away from the Tropics

• Politics Makes Strange Bedfellows and Infectious Diseases: Did you know that changing political alliances in the 1960s helped introduce the Aedes albopictus mosquito (also known as the Tiger mosquito) to Europe? In the 1960s, an alliance between China and the former USSR ended. However, Albania, a highly communist country in Europe, continued its ties with China. As a result, they frequently imported equipment from China in containers that also carried an unwanted visitor – the Tiger mosquito. Luckily, as Albania did not permit much travel in and out of the country, the mosquito was contained.
• The Side-effects of Globalization: The Aedes mosquito first entered the United States in the 1980s due to tire imports from Japan. As Europe began imports from Japan in the 1990s, the mosquito began to spread there as well.

Modeling and Tracking the Spread

Dr. Hendrickx shared several significant studies about the spread of mosquito-borne vectors and how his team has been instrumental in tracking and predicting the spread of the Tiger mosquito. He stressed that studying the import of vector-borne diseases is essential to help curb outbreaks.

Comparing Clinical Features

Dr. Stephen Berger discussed how it might surprise people to know that mosquito-borne diseases are more common in the United States than people may think. After all, the most common condition affecting all American Presidents is not heart attacks or cancer, but malaria! Even more surprising, almost all (except two) got their malaria within the United States, not from another country.

Dr. Berger stressed the importance of clinicians conducting differential diagnoses to compare clinical symptoms and identify mosquito-borne diseases early. This way, a country can curb import-based outbreaks.

Dr. Berger used the GIDEON differential diagnosis web app for a demonstration. He showed how adding ‘insect bites’ to a list of symptoms can help clinicians narrow down potential diagnoses to arrive at the most probable one.

Image: GIDEON differential diagnosis of mosquito-borne illnesses in the United States. The list is ranked by statistical probability. 

The Need for More Data-Driven Research on Diseases Like Zika, West Nile Virus, and Other Types of Fever

West Nile virus is one of the most severe mosquito-borne diseases that Dr. Berger treats. He mentioned that West Nile is more common in adults than in children. However, he also stressed that there is still an excellent opportunity for further research on several topics. For example, is West Nile more common in adults solely due to physiology? Or are there social factors – for example, children may not be allowed out at night? This may reduce their exposure to the virus.

Image: West Nile Fever World Outbreak Map, 1955 to 2020. Copyright © GIDEON Informatics Inc.

Similarly, St. Louis encephalitis can even be fatal for adults, but children are mainly unaffected. Why is this so? More research in this field can offer greater insight.

Dr. Jones and the panel also discussed the challenges and industry best practices to curb the import and export of vector-borne diseases at different ports of entry.

For more, please watch the GIDEON, Avia-GIS, and the University of Florida collaborative webinar on the Invasive Aedes Mosquitoes: Dengue, Chikungunya, and Zika risks in Florida and the United States.

The GIDEON Difference in Public Health

GIDEON is one of the most well-known and comprehensive global health databases for infectious diseases and it plays an important role in public health and safety. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Less-Common Flaviviruses, Microsporidiosis, Neutropenic Typhlitis, Old-World Spotted Fevers, and more. Or check out our global status updates on countries like Guinea, Lithuania, Moldova, Niger, and more!

The post Mosquito-borne Diseases Dengue, Zika, and Chikungunya in the United States appeared first on GIDEON.

Image: 3D illustration of Clostridium tetani, the agent of Tetanus

There’s an urban legend about Tetanus shots. Many people feel you need them only when you step on a rusty nail or if a splinter pokes you. Like any good myth, there is a tiny bit of truth attached to it. Yes, stepping on a nail is a good reason to get a Tetanus shot – but not because of the rust. Once your skin barrier is ruptured, bacterial spores from contaminated items can easily enter your body.

The truth is there are many ways to get Tetanus. Spores of the bacteria that cause infection development, Clostridium tetani, are commonly found in the soil, dust, intestines, and feces of several household animals, herbivores, and even humans. However, it does not spread from one person to another. The best way to control infections is to prevent them from occurring entirely.

Epidemiology: Recent and Older Outbreaks

Worldwide, cases have declined rapidly due to mass immunization drives by various governments and public health agencies. However, Russia recently reported its first case in nearly two decades in September 2021 [1]. In India, a 12-year-old boy recently survived a severe case [2]. He had not been vaccinated against it. In Northern Kazakhstan, a 53-year-old man died due to Tetanus, and it is not known if he was vaccinated [3].

One potential reason for these new reports of this highly preventable infection is COVID-19.  In July 2020, WHO and UNICEF warned of disruptions to life-saving immunization services across the world due to the pandemic. Healthcare workers and social workers have been unable to follow standard vaccination schedules for many reasons, including:

• Lockdowns and social distancing,
• Disruption to transportation,
• Fear or reluctance to visit hospitals or clinics for non-urgent health services,
• More healthcare workers diverted towards COVID-19 and emergency services, and
• A lower number of available auxiliary nursing midwives (ANMs) to drive regional vaccination for children.

Before the pandemic, two notable outbreaks occurred in Indonesia during the devastating tsunami in 2005 and an earthquake in 2006. People hurt in disasters are, in general, at a much higher risk of getting infected. In certain parts of Indonesia, a lack of adequate transportation, access to health facilities, and awareness about protocols led to many people dying. Another instance of an outbreak was after the 2005 earthquake that struck Pakistan [4].

Image: Worldwide Tetanus cases and rates, 1980 to 2020. Copyright © GIDEON Informatics, Inc.

What Causes Tetanus? What are the Symptoms?

Tetanus is one of the deadliest microbial toxins. It is caused by the bacteria Clostridium tetani and has a high fatality rate. Approximately 10-20% of cases are fatal.

It is also commonly known as lockjaw. Spores of the bacterium, Clostridium tetani, enter our bodies and spread all over the nerves in the central nervous system. The spores produce a toxin called tetanospasmin that blocks nerve signals from the spinal cord to the rest of the muscles. The condition is also commonly known as lockjaw because it often causes severe muscle spasms in the jaw and neck, as well as stiffness, though it may spread to the rest of the body.

Other symptoms are fever, sweats, a rise in blood pressure, and an elevated heart rate. A common complication of Tetanus is when vocal cords begin to spasm, causing breathing difficulties. Infected individuals can also break their bones or spines based on the severity and frequency of convulsions caused by the disease[5].

About Clostridium Tetani

Tetanus disease spores cannot be killed easily. They are found everywhere and can resist extreme conditions like high heat and strong disinfectants. They can remain inactive but infectious for more than 40 years.

Clostridium tetani is an anaerobic bacterium; it does not live or grow in the presence of oxygen. As a result, there is a higher risk of infection with injury sites that do not receive a strong oxygen supply. This includes deep wounds, burns, needle punctures, and surgical procedures performed without adequate hygiene protocols.

While infection can have serious effects, it is now rare in most developed countries. The United States reports an average of 20 cases per year, mostly in unvaccinated individuals. Though most cases are found in developing countries, many of them now maintain rigorous vaccination programs and made great strides in eliminating or minimizing the incidence of disease. Anyone can get infected, but children and newborns (when infected are known to have neonatal tetanus) are the most susceptible.

Image: Clostridium tetani. Anatomy of the cell with terminal spore, and vegetative cell. Structure of the terminal spore: core, cortex, and spore coat.

What is the Incubation Period?

The incubation period for Tetanus is anywhere from three to twenty-one days, with an average of ten days. The incubation period varies based on how far the injury site is from the central nervous system. Symptoms can last for weeks and even months. They are higher in unvaccinated individuals and older people for whom immunity is lowered.

Is There a Cure for It?

There is no cure for the disease, but the vaccine is highly effective in preventing infection. Once infected, however, symptoms are managed until the effects of the toxin diminish. Chances of survival are lower if muscle spasms develop within five days of getting infected.

There are no blood or laboratory tests to diagnose Tetanus. The most common initial symptom is ‘trismus’ or lockjaw due to facial muscle spasms.

Tetanus can be confused with certain other conditions, which makes it more important to educate frontline clinicians about confirming their own initial assessments either with experts or a platform like GIDEON that factors epidemiology data into differential diagnosis.

How Do Medical Professionals Treat It?

Tetanus is considered a medical emergency, and hospital care is required. Treatment is often medication called Tetanus Immune Globulin (TIG), also known as an antitoxin. It is usually administered as a preventive measure for high-risk wounds and injuries. It is also part of the treatment protocol, together with medicine. These medicines include muscle relaxants and antibiotics like penicillin. When required, proper wound cleaning and debridement are also essential to minimize the risk of infections. Patients with difficulty swallowing may also need a breathing tube or ventilator [6].

Vaccines for Preventing the Risk of Infections

The best prevention is to ensure newborns, children, and adults receive their Tetanus vaccine doses according to the recommended schedule.

Vaccines for the disease are often combined with those for other diseases:

• DT Vaccines: Diphtheria and Tetanus
• DTaP or DTP Vaccine: Diphtheria, Tetanus, and Pertussis (whooping cough)
• Td Vaccine: Tetanus and Diphtheria
• Tetanus Immune Globulin (TIG)

It is important to note that vaccines do not offer lifetime immunity. Many people may need booster shots to continue receiving protection against Clostridium tetani. Additionally, building awareness about improved infection control measures for childbirth, surgery, and other medical protocols in developing and under-resourced nations can make a difference.

Image: WHO-UNICEF estimated vaccine coverage of Tetanus graph, 1980 – 2019. Copyright © GIDEON Informatics, Inc.

The GIDEON Difference in Health

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes in history or present studies, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Less-Common Nematodes, Miscellaneous Animal Bite Infections, New World Phleboviruses, and more. Or check out our global status updates on countries like Guyana, Luxembourg, Monaco, and more!

References

The post Tetanus: What to Do About This Deadly Infection? appeared first on GIDEON.

Image: Brugia malayi in blood, a roundworm nematode, one of the causative agents of lymphatic filariasis, 3D illustration showing the presence of sheath around the worm and two non-continuous nuclei in the tail

Lymphatic Filariasis, commonly known as Elephantiasis, is considered a Neglected Tropical Disease (NTD). This is unfortunate because the disease is the second leading cause of permanent and long-term disability in the world! [1] As of 2019, it continues to be a threat to over 859 million people in over 70 countries. 

Like other Neglected Tropical Diseases, it is endemic to low-income regions of the globe that deal with poor water quality, sanitation, and limited access to healthcare. India accounts for 47% of chronic Filariasis and 39% of the at-risk population [2]. The good news is that it is considered “potentially eradicable” and can be prevented through timely treatment. Disease spread can be controlled through mosquito control measures [3]. 

But what is this disease? What are the different types of Lymphatic Filariasis? Where is it found? How do we treat it? 

What is Lymphatic Filariasis? 

Lymphatic Filariasis is an infectious tropical disease caused by parasitic roundworms (nematodes) transmitted by mosquitoes. The disease is named after the family of worms, Filariodidea.  

The disease affects the lymphatic system – the intricate network in our body that is an integral part of our circulatory and immune systems. It can cause severe swelling and disfigurement; body parts may swell up to abnormal proportions. 

Because of the resulting disfigurement and pain, people suffering from Lymphatic Filariasis often face social isolation and loss of income, leading to mental health issues and greater poverty. 

In recent years, the World Health Organization (WHO) and high-risk countries, have organized mass treatment of all eligible people against Lymphatic Filariasis. This type of preventable chemotherapy has successfully proven to help stop the spread of infection [4].  

What are the Types? 

There are three types of Lymphatic Filariasis based on the type of pathogen that causes the disease – Bancroftian, Brugia malayi, and Brugia timori.

1. Bancroftian Lymphatic Filariasis

Bancroftian Lymphatic Filariasis comprises 90% of all lymphatic filariasis cases around the world. It is caused by a worm called the Wuchereria bancrofti (W. bancrofti). The earliest descriptions of Bancroftian Filariasis dates as far back as 600 B.C. in India! The disease is named after the dynamic father-son duo of eminent Australian doctors and parasitologists Dr. Joseph Bancroft and Dr. Thomas Bancroft. 

The W.bancrofti worm needs two hosts to complete its life cycle. It sexually reproduces in humans and matures in Anopheles mosquitoes. This has a long incubation period of anywhere from 5 – 18 months, making it harder to detect early without preventive care in high-risk areas.

Image: Advanced Elephantiasis – a patient in the Philippines

2. Brugia malayi

The Brugia malayi is a type of roundworm that relies on Mansonia and Aedes mosquitoes as vectors. The adult worms that grow in a human’s lymphatic system are similar but smaller to the W.bancrofti. Human infection often includes swollen lymphatics of the neck, groin, or axilla. 

Brugia malayi is endemic to South and Southeast Asia. It usually takes many bites from mosquitoes carrying the Brugia malayi pathogen before a human can be infected. This is why high-risk countries need to improve their sanitation and water quality standards. Additionally, they need to periodically perform proactive mass drug treatments proven to be effective against Lymphatic Filariasis. 

3. Brugia Timori

Brugia timori is a roundworm that uses the Anopheles mosquito as its vector. The life cycle of this worm is similar to the W.bancrofti and Brugia malayi. The prevalence of this variety of Lymphatic Filariasis is much less compared to the other two. It is usually limited to Timor and the Lesser Sunda archipelago of southeast Indonesia [5]. 

A review of Brugia timori on the GIDEON database shows that the number of people infected by Brugia timori is estimated to be less than 800,000. 

There are many similarities in symptoms of the three types of Lymphatic Filariasis, but differences do exist. Below is a dynamic comparison chart generated by the GIDEON platform for symptoms of W.bancrofti, Brugia malayi, and Brugia timori infections.

Image: Comparison chart for clinical findings related to Bancroftian, Brugia malayi, and Brugia timori Lymphatic Filariasis. Copyright © GIDEON Informatics, Inc.

What is the Best Treatment?  

Treatment for Lymphatic Filariasis is concentrated around large-scale chemotherapy known as mass drug administration (MDA). WHO recommends an annual dose of preventive chemotherapy drugs to high-risk populations:

• Albendazole (400 mg) alone twice per year for areas co-endemic with loiasis
• Ivermectin (200 mcg/kg) with albendazole (400 mg) in countries with onchocerciasis
• Diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg) in countries without onchocerciasis [4]. The United States falls in this category. 

In countries without onchocerciasis (river blindness, another type of Filariasis), WHO also recommends ivermectin (200 mcg/kg) together with diethylcarbamazine citrate (DEC) (6 mg/kg) and albendazole (400 mg) in certain settings. 

Image: The global number of people targeted for mass drug administration (MDA) for Filariasis. Copyright © GIDEON Informatics, Inc.

Some studies have shown that Doxycycline administered over six weeks significantly improved the severity of Lymphatic Filariasis in patients with and without active infection. Doxycycline worked to revert or halt the progression of early stages of Lymphatic Filariasis (1-3), not later ones [6]. Doxycycline is an antibiotic often touted as a ‘wonder drug’ because it can kill various pathogens in situations where other antibiotics may fail, like for malaria and against Yersinia pestis, the bacteria responsible for the Plague. The effects of Doxycycline last for a while, so it is effective for both treatment and prevention. 

Image: A graph illustrating countries enrolled on mass treatment programs for Filariasis. Copyright © GIDEON Informatics, Inc.

How to Prevent the Spread of This Disease

Apart from MDA methods, stringent vector control is essential to eliminate or reduce the incidence of Lymphatic Filariasis. Studies show that vector control after MDA is extremely effective in reducing the resurgence of the disease and preventing spread. Vector control includes bed nets and the regular spraying of insecticides to prevent mosquito bites [7]. 

Additionally, more researchers are beginning to incorporate the epidemiological impact of infectious diseases in their studies. For example, over 20 research papers used GIDEON epidemiology data on infectious diseases as part of their parasitology-focused papers in the past three years alone. This is a welcome trend that can raise awareness about neglected tropical diseases, preventive measures and help drive much-needed resources towards mitigating the devastating effects of these parasites. 

References

The post Lymphatic Filariasis: Everything You Need To Know About This Neglected Tropical Disease appeared first on GIDEON.

Understanding the spread of diseases and epidemiological data can help clinicians and nurses detect and curtail infections early. Public health and government agencies prevent the spread of emerging infectious diseases on their shores.  Here are the most common epidemiological metrics to help you get started, in a handy epidemiologic glossary.

Incidence

Incidence refers to the probability of a disease occurring in a given population in a specific time period. The incidence measures new cases that develop or are diagnosed in a month or a year. For example, if there are 100 new cases of plague within a city of 1,000 people in one year, the incidence rate would be 10%. Likewise, if there are 80 new cases of plague in a city of 1 million people in a year, the incidence rate would be 8 per 100,000 people. Both methods of representation of incidence rate are accepted as they are both numerical statistical measures that are clearly recognized by the epidemiology and public health industries.

We can see this visually represented with outbreak or case maps. We can compare the two GIDEON maps below that are color-coded based on incidence. The first map is an outbreak map for the plague and the second is that for SARS-COV-2 or COVID-19. Between the two, even at first glance, we can identify the higher incidence of COVID-19 versus the current endemicity of the Plague.

Plague global outbreaks map, years 1348 to 2021.

 COVID-19 global outbreaks map, illustrating disease incidence between the years 2019 to 2021

This information is important to epidemiologists because it helps them to understand how diseases spread and identify possible interventions to stop the spread of disease. If the incidence rate of the plague is increasing, epidemiologists may recommend measures such as quarantining infected individuals or spraying public areas with insecticide to prevent further spread. By tracking incidence rates, epidemiologists can play an important role in protecting populations from potentially deadly diseases. Data like incidence rates, especially when displayed visually like in GIDEON can be used to form an operational research hypothesis and lead to the start of in-depth studies.

Prevalence

Prevalence is the share of a population affected by a given condition at a specific point in time. It can be assessed for various conditions, including diseases, risk factors, and health behaviors. Unlike incidence, which measures how many people develop a condition over a specific period of time, prevalence captures the total number of cases at a given point. It is typically expressed as a percentage or as the number of cases per 100,000 people.

Prevalence is important for public health surveillance and epidemiology because it provides information on the overall burden of disease in a population. This can help inform allocation of resources and target interventions to reduce the disease burden. Prevalence data can also be used to monitor trends over time to assess whether interventions are having an impact.

There are two main types of prevalence:

• point prevalence
  • Point prevalence is the proportion of people affected by a condition at a specific point in time (e.g., 3% of the population has diabetes).
• period prevalence
  • Period prevalence is the proportion of people who have had the condition at some time period.

Checking Out Chickenpox as an Example

The prevalence of chickenpox in Europe can be used by epidemiologists to combat the disease. For example, epidemiologists can study the prevalence of chickenpox in different countries and regions to identify areas where the disease is more common. This information can then be used to develop strategies to reduce the prevalence of chickenpox in those areas. The difference between point prevalence and period prevalence is important to know because it can help epidemiologists to understand how the prevalence of disease changes over time.

Chickenpox is an example of a disease with a high point prevalence but a low period prevalence.  Since the point prevalence of chickenpox is high, but the period prevalence is low, this may indicate that the disease is spreading rapidly. We also know that most people who get chickenpox will recover from the disease within a few weeks while some people will develop complications from chickenpox and will remain affected by the disease for longer periods of time.

If both measures are high, this may indicate that the disease is endemic (constantly present) in the population. Chickenpox is a highly contagious disease, so it is important for epidemiologists to track its prevalence to combat its spread.

Incidence Versus Prevalence

Prevalence and incidence data are two of the most important tools used by epidemiologists to track the spread of disease. We know that prevalence is a measure of how many people are currently infected with a disease, while incidence is a measure of how many new cases of disease there are in a population over time. Both prevalence and incidence data are essential for understanding the spread of disease and developing an effective response.

Let’s look at infections from COVID-19 (SARS-COV-2) as an example. In December 2019, when the first outbreak happened, incidence and prevalence numbers worldwide were low. By March 2020, incidence numbers (newly diagnosed cases) were high. Global prevalence numbers were still low because the virus hadn’t spread to the larger population. But by July 2021, worldwide incidence and prevalence numbers were high due to highly infectious variants.

The high incidence of COVID in the early months of the pandemic indicated that the disease was spreading rapidly and that immediate action was needed. The prevalence data showed that the disease was still active in many parts of the world, even as some countries began to see a decline in new cases. 

During the COVID pandemic, we saw these metrics used in practice all over the world. Specifically, prevalence data was used by global health experts and epidemiologists to track the overall number of cases and understand how the disease was spreading. This information was essential for epidemiologists in developing disease control measures such as travel restrictions and quarantines. Incidence data were also used to track the number of new cases and identify hot spots where the disease was spreading rapidly. This information was critical for identifying areas that needed targeted interventions.

Overall, prevalence and incidence data played a vital role in guiding the response to the COVID pandemic. By understanding how the disease was spreading, epidemiologists were able to develop more effective control measures and target interventions to areas where they were needed most.

Seroprevalence

Seroprevalence refers to the number of people in a population who test positive antibodies to a pathogen (infectious virus or bacteria). Seroprevalence to an antibody to a virus or pathogen can give us an idea of the number of people infected.  Seroprevalence is expressed as the percentage of people with antibodies to an infectious agent. For example, if 10% of people have been infected with a certain virus, then the seroprevalence for that virus would be 10%.

It is used to track the spread of infection and can be helpful for public health officials in determining which populations are most at risk for certain diseases. In a medical laboratory, seroprevalence testing is done by taking a blood sample from a person and then testing it for the presence of antibodies. Antibodies are proteins that the body produces in response to an infection. This is also known as serologic testing of a sample, it specifically measures the level of antibodies against a pathogen in serum (the clear fluid portion of blood). This type of sample testing is often used to screen blood donations for infectious agents.

One of the key advantages of seroprevalence testing is that it can help to identify asymptomatic individuals who may have unknowingly spread the disease. This information is critical for developing an effective disease response and ensuring that adequate resources are allocated to containment efforts. Additionally, by tracking changes in prevalence over time, these tests can also provide valuable insights into the efficacy of containment measures. This information helps public health professionals to plan disease control measures and to evaluate the effectiveness of disease response strategies.

It’s especially helpful to combine prevalence data with seroprevalence data since they both give a better view of the whole picture of a condition or disease. Prevalence of a disease can be affected by many factors, including the age of the population, the incidence of the disease, and the number of people who have died from the disease while the seroprevalence of a disease can be affected by the same factors, but it can also be affected by how long ago people were exposed to the disease.

Seroprevalence Survey or Serosurvey

A seroprevalence survey involves blood serum testing of a population and monitoring whether a particular substance is present or absent in the sample. This type of study is helpful in determining the health of the population. It is a type of epidemiological study that looks at the prevalence of antibodies to a particular disease in a population. Blood samples are collected from individuals and then tested in a laboratory for the presence of antibodies. The data can be used to estimate the prevalence of infection with a given pathogen and assess the effectiveness of vaccination programs. This can be invaluable when creating a hypothesis, conducting exposure research, or other statistical analysis based on population health.

These seroprevalence surveys can be tailored based on how widespread or localized the infection is. These studies and their data help epidemiology officials understand how an infectious agent or pathogen spreads across a specific population over a period. 

COVID-19 United States Seroprevalence studies list screenshot, Country Note from GIDEON database.

Morbidity Rate

Simply put, morbidity means disease therefore the morbidity rate measures how often a specific disease or illness occurs in a given population and includes acute and chronic conditions. More specifically, a morbidity rate measures the prevalence of a particular medical condition in a population. It is typically expressed as the number of cases of the disease per 100,000 people. It’s important to note that morbidity is different from mortality, which refers to the number of deaths in a population. The metric is used by public health officials, governments, healthcare systems, epidemiologists, and many more to estimate the overall health of a given population.

There are lots of different ways to measure morbidity, but one of the most common is through something called the Disability-Adjusted Life Year (DALY) score. This score considers both the length and quality of life lost due to premature death or illness. Ultimately, the goal is to develop a single number that gives us a good sense of overall population health.

The morbidity rate is expressed as a percentage of the number of cases of a specific disease or condition in a given population.  The statistical value of a morbidity rate depends on how it is calculated. For example, if only people who seek medical treatment for their condition are included in the numerator (the top number), then the resulting rate will be lower than if all cases of the infection are included. A higher morbidity proportion indicates a greater number of people suffering from illnesses or diseases. 

Anthrax as an Example

Anthrax morbidity rates in the United States have varied widely over time, with a few hundred cases reported each year in the early 1900s, then declining to just a handful of cases per year by the late 1940s. However, there was a resurgence of anthrax cases in the 1970s, with an average of 55 cases per year being reported during that decade. Cases then declined again in the 1980s and early 1990s but rose to an average of 30 cases per year from 2001 to 2008.

The increase in morbidity rates in the United States since 2001 can largely be attributed to bioterrorism-related Anthrax scares. In 2001, there were 22 confirmed cases of anthrax, and the morbidity rate was 7 per 100,000 people. This was the highest morbidity rate since 1987 when there were 3 confirmed cases of anthrax, and the morbidity rate was 0.1 per 100,000 people. This led to widespread panic and increased vigilance for Anthrax cases, which likely reported more cases.

In 2013, there was 1 confirmed case of anthrax, and the morbidity rate was 0.3 per 100,000 people. Although the number of cases has decreased, the morbidity rate remains higher than it was prior to 2001. However, it is essential to note that the morbidity rate (cases per 100,000 population) has remained relatively stable over time, hovering around 1 case per million people since the early 1990s.

Anthrax (Bacillus anthracis) annual cases in the United States, 1930 – 2020.

Attack Rate (AR) or Incidence Proportion

The history of incidence proportions dates back to the early days of epidemiology when British physician John Snow first used them to track the spread of cholera in London in 1854. Snow noticed that the incidence of cholera was higher in certain neighborhoods, and he believed that this was due to contaminated water sources. By mapping the incidence of cholera, Snow was able to identify the tainted water pump and persuades authorities to disable it, effectively halting the outbreak. Since then, incidence proportions have been used to track a variety of infectious diseases, including polio, AIDS, and tuberculosis. Today, they remain an essential tool in the fight against infectious diseases.

The term “attack rate” is used in public health to refer to the incidence proportion of the number of new disease cases divided by the number of people at risk for the disease. Since it measures the proportion of people who develop a specific condition or illness in a population initially free from that disease or illness, this variable is commonly used in epidemiology to track disease outbreaks. Public health officials use the metric to estimate how many individuals may be infected during an epidemic or pandemic. 

Speaking in a numerical sense, the Attack Rate or Incidence Proportion is calculated as the number of new cases of an infection in the total at-risk population and expressed as a percentage.  By tracking attack rates, epidemiologists can identify areas where diseases are spreading and take steps to contain the outbreak. In this way, incidence proportions play an important role in protecting public health.

Secondary Attack Rate (SAR)

The Secondary Attack Rate estimates the spread of infection from an individual to people in their household, residential area, or another specified group of people at risk of getting infected (like hospital staff). SAR is a critical metric during contact tracing for infectious diseases.  The secondary attack rate is expressed as a percentage like the attack rate. It is the number of new cases of an infection developed among a person’s contacts out of their total number of contacts. 

Incidence Rate (IR) or Incidence Density Rate or Person-Time Incidence Rate

The incidence rate measures the number of new disease cases occurring in a given population during a specified timeframe.  The incidence rate is often expressed as the number of new cases per 100,000 population. Public health officials use incidence rates to track the spread of infections and to identify populations that are at risk for developing serious illnesses.

For example, the incidence rate of influenza in Asia is currently very high. This means that there is a large number of new cases of the flu occurring in Asia each day. In fact, it’s one of the highest in the world. This is concerning because the flu can be quite dangerous, particularly for young children and the elderly. However, incidence rates can vary depending on the region. For example, the incidence rate of influenza in North America is currently much lower than in Asia.  The incidence rate of the flu in Asia has actually been declining in recent years. This is likely due to better hygiene practices and greater awareness of the importance of vaccinating against the flu.

Knowing the incidence rates can help us to slow the spread of the infection by identifying areas where the flu is more likely to occur and by taking steps to prevent its spread to other regions.

Mortality Rate (MR)

The word mortality comes from the Latin word mortalitas, which means “death.” The first recorded use of the term mortality rate was in a 16th-century medical text. The first disease to be discovered to have a mortality rate was cholera. Cholera is a disease that affects the gastrointestinal tract and is caused by contaminated food or water. Yes, that same cholera that was mentioned alongside the father of epidemiology himself, John Snow! The mortality rate for cholera is very high, and it is one of the most deadly diseases in the world.

The mortality rate or death rate helps us understand how frequently death occurs in a given population in a specific amount of time. The metric is expressed as deaths per 1,000 individuals per year or 100,000 individuals per year. The mortality rate for a disease is also expressed as a percentage of the total number of cases.

The disease with the highest mortality rate is HIV/AIDS. As of 2016, the mortality rate for HIV/AIDS was 38%. In contrast, the mortality rate for heart disease was 17%, and the mortality rate for cancer was 23%. However, it is crucial to keep in mind that mortality rates can vary depending on a number of factors, such as the age of the population being studied. Still, these figures give us a general idea of which diseases are most deadly.

Dengue is also a disease of note when assessing mortality rates. Dengue mortality rates vary widely from year to year, and from place to place.

Dengue Mortality Rates for India, 1991 – 2020.

Mortality rates from dengue are quite high in many countries, but they are particularly high in India. In fact, mortality rates from dengue in India are some of the highest in the world. In India, the death rate is at around 1%. This compares to mortality rates of around 0.1% in Vietnam and Thailand and 0.01% in Sri Lanka. Dengue mortality rates in India are more than double the mortality rates from dengue in other countries. The high mortality rate from dengue in India is due to a number of factors, including the large population of people living in close proximity to each other, the lack of access to quality healthcare, and the lack of knowledge about how to prevent and treat the disease.

Epidemiologists can use mortality rates to help combat the disease by understanding where it is most prevalent and by developing strategies to target those areas. mortality rates can also be used to track the progress of efforts to combat the disease. However, mortality rates are not the only important factor when it comes to measuring the impact of a disease. The number of people who contract the disease is also important, as is the number of people who recover from it. In India, around 1 million people are thought to contract dengue fever each year, with around 10% of those developing severe dengue. However, the majority of people recover from the disease without any lasting effects. This means that, while the mortality rate from dengue may be relatively high in India, the overall impact of the disease is relatively low. This is something that epidemiologists will consider when devising strategies to combat dengue fever in India.

Crude Mortality Rate

Crude mortality rate measures the total number of deaths in a population during a specific period of time. It is called ‘crude’ because the number includes all deaths and provides a high-level estimate of fatalities during a humanitarian crisis. It can be expressed as deaths per 1,000 or 100,000 individuals per year. 

Case-fatality Rate (CFR) or Case-fatality Proportion

The case-fatality rate is used to understand the severity of a disease, evaluate new therapies, and predict how a condition will continue to affect a given population. It estimates the percentage of individuals who die from a specific disease among all people diagnosed with the disease for a given period. It is best applicable for diseases with particular starts and stops, like acute infections or outbreaks. It is not a rate but the proportion of deaths due to a specific disease condition.  It is expressed as a percentage. A higher percentage indicates greater disease severity due to more deaths from the disease. 

Cause-Specific Mortality Rate

The cause-specific mortality rate is the number of deaths from a particular cause in a population during a given time interval (usually a calendar year).  It is expressed as deaths per 100,000 individuals.  It is different from the case-fatality rate, which is not precisely a rate but a proportion of deaths in a population from a particular disease. 

Age-Specific Mortality Rate

The age-specific mortality rate gives us the mortality rate for a specific age group of individuals in a given population. It is also often known as the age-adjusted mortality rate. It is the best way to understand diseases highly influenced by age and their impact on a population. This metric is commonly used to understand the rates of heart disease conditions, strokes, diabetes, cancer, and more in a population.  Age-specific mortality is expressed as deaths per 100,000 in an age range.  

Maternal Mortality Rate (MMR)

The maternal mortality rate is a ratio that helps us understand how many women die from pregnancy-related complications in a population. It is the number of maternal deaths by the total number of live births in a given period. MMR is expressed as deaths per 100,000 live births. The MMR is a significant health indicator for a country or a given population because most pregnancy-related deaths are preventable. The most considerable pregnancy-related complications include bleeding after childbirth, infections, high blood pressure during pregnancy, and issues that arise during delivery.  

While the maternal mortality rate has declined significantly in developed countries over the past few decades, it remains a significant public health problem in many parts of the world. In fact, the maternal mortality rate in developing countries is more than 14 times higher than in developed countries. In developed countries, the maternal mortality rate is lower, but it is still a cause for concern. The main cause of high maternal mortality rates is poor access to quality health care. Other factors that contribute to high rates include poverty, lack of education, and poor nutrition.

Public health interventions that have been shown to be effective in reducing maternal mortality include strengthening the health care system and improving nutrition. Other interventions that effectively reduce maternal mortality rates include improving access to skilled birth attendants and emergency obstetric care, providing antenatal care and postnatal care, and increasing awareness of danger signs during pregnancy. While there is still much work to be done, it is important to continue to invest in public health interventions that can save the lives of mothers around the world.

Infant Mortality Rate (IMR)

The infant mortality rate measures the probability of a child born in a specific period dying before it turns one. It helps us understand the likelihood of a newborn infant surviving in a particular population. Since the probability of survival is closely linked to the social structures, economic, and health conditions, it is often a significant indicator of a nation’s health. It is expressed as deaths per 1,000 live births. 

In public health and epidemiology, the infant mortality rate is used as a marker of the health of a population and a measure of the effectiveness of health interventions. It is also an important indicator of social and economic conditions. There are many factors that contribute to high infant mortality rates. These include poverty, poor nutrition, lack of access to healthcare, and unsafe delivery conditions. Infectious diseases are also a major cause of death in infants, particularly in developing countries where immunization coverage is low. diarrhea and pneumonia are the leading causes of death in children under five years old, accounting for around 15% of all child deaths globally.

The developed country with the highest infant mortality rate is the United States, with an IMR of 5.8 in 2018. This is near twice the rate in Canada (3.0) and almost three times the rate in Finland (2.3) and Japan (2.1). In 2015, the global infant mortality rate was 31 deaths per 1,000 live births. However, there is significant variation in mortality rates between countries. The five countries with the highest mortality rates are all in Africa:

• Somalia (110)
• Mali (93)
• Central African Republic (86)
• Pakistan (82)
• Afghanistan (80)

The five countries with the lowest mortality rates are all in Europe:

• Monaco (1)
• Iceland (2)
• Finland (3)
• Norway (3)
• San Marino (3).

Public health interventions such as immunization programs, improved nutrition, and access to clean water and sanitation can help lower infant mortality rates. In developed countries, advances in medical care have also played a role in reducing the IMR.

Endemic

The term endemic is used to refer to anything that naturally occurs and is confined to a particular location, region, country, or population. An endemic disease is one that is constantly present in a particular population or geographic area. The word endemic can trace its origins back to the Greek word endemos, meaning “inhabited.” Endemic diseases were first classified by Hippocrates, who divided them into two categories: those that were always present in a given location, and those that periodically erupted.

Today, endemic diseases are typically classified as either sylvatic or zoonotic. Sylvatic endemic diseases are primarily found in animals and only occasionally affect humans, while zoonotic endemic diseases can be transmitted between animals and humans. Endemic diseases are typically found in developing countries with poor sanitation and limited access to healthcare.

The first disease to be classified as endemic was malaria, which is endemic to tropical regions of the world. From the malaria outbreak map below, we can see that chloroquine-resistant malarial strains are endemic to specific regions in South Asia, Africa, and South America. Malaria is endemic to over 100 countries, primarily in Africa, Asia, and South America.  Today, there are many diseases that are endemic to specific countries or regions. For example, endemic diseases in Britain include brucellosis and vCJD, while in South America, Chagas disease is endemic.

Endemic diseases can pose a major challenge to epidemiologists, who must work to control and prevent the spread of these diseases. In some cases, endemic diseases can be brought under control through vaccination or other public health measures. However, in other cases, endemic diseases may be difficult to control due to a lack of resources or difficulty accessing affected populations.

Malaria – current endemicity and historical outbreaks map.

Epidemic

An epidemic affects many people at the same time. In an epidemic, there is a sudden increase in disease infections that spreads in a region or locality where the disease condition is not naturally found. The word epidemic is derived from the Greek epi-, meaning “upon,” “in addition to,” or “in excess of,” and demos, meaning “people.” An epidemic is therefore literally “upon the people.”

The first known usage of “epidemic” in English was in the early 14th century when it was used to describe the constantly recurring waves of disease that swept Europe during the Middle Ages. The first epidemic disease to be classified was the plague, which caused the Justinian Plague. At that time, epidemic simply meant “prevalent among a people or community at a given time.”

In 1847, an epidemic was used to describe a disease that spreads rapidly and simultaneously affects many people. The first disease to be classified as an epidemic in a modern medical sense and in medical texts was cholera.

An epidemic has three main components:

• a large number of cases of a disease,
• appearing in a population over a relatively short period of time, and
• spreading from person to person.

Epidemiologists are health professionals who study the patterns and causes of diseases in order to control their spread. They use this information to develop strategies for prevention and treatment. By understanding the factors that contribute to the spread of epidemic diseases, epidemiologists can help to save lives. There are some other terms in relation to epidemics that are critical to know such as:

• Outbreak
  • An outbreak is a sudden increase in the number of people infected by or diagnosed with a specific disease condition. It is similar to an epidemic but usually restricted to a much smaller locality or geographic location.
• Pandemic
  • A pandemic is an epidemic that has spread to several countries or continents. It usually affects a much larger group of people than an epidemic.

The post Epidemiology Terms: A Glossary of Epidemiological Words appeared first on GIDEON.

Photo by Satheesh Sankaran on Unsplash

Could your patient have kissed a camel recently? A new patient may have fallen ill after indulging in a little ‘tari’ (fermented date palm sap) in Southeast Asia. Or could your hospital be in the midst of a Candida Auris outbreak – the multi-drug resistant, severe-illness causing, and often-misidentified yeast?  

When you need to identify an unknown pathogen or biothreat agent, as the title song of the movie ‘Ghostbusters’ goes, “Who you gonna call?” If you’re in Maryland, Sheryl Stuckey and her clinical microbiology lab at the Holy Cross Hospital, Silver Spring, may be the help you need.

“The system has been helpful in preparing continuing education for my team.  It helps us with unusual organisms and steering us toward possibilities when people have traveled or reside in other countries.”

Sheryl Stuckey, Manager, Microbiology Lab
Holy Cross Hospital, Silver Spring, Maryland, USA

Accuracy and Efficiency: Challenges of a Busy Clinical Microbiology Lab 

Running a Full-Fledged Lab 

Led by Sheryl Stuckey, the Microbiology lab at the Holy Cross Hospital, Silver Spring, Maryland, has to run with a high level of efficiency. It is usually abuzz with energy from handling a wide range of tasks for the hospital and external agencies. Although the hospital is a community hospital with 450+ beds, it serves patients from all over the world. Even the staff is diverse and represents over 80 countries. But that’s not all. 

Expert in Infectious Diseases and Pathogens 

Sheryl faces an added layer of responsibility – she is the lab tech for clinical microbiology in her hospital, and no one else in her chain of command knows this diagnostic area. Hospitalists (physicians who specialize in treating hospitalized patients) often reach out to Sheryl for help with identifying or confirming a pathogen diagnosis. 

For example, she recently helped a hospitalist identify MERS (Middle East Respiratory Syndrome, also known as ‘camel flu’). While the physician suspected something else, the microbiology lab suggested checking for the patient’s travel history. Says Sheryl, “He hadn’t thought to ask, and when he did, he learned that she had traveled to the Middle East and kissed a camel. Crazy, right?”

Image: GIDEON database MERS worldwide distribution notes. Copyright © GIDEON Informatics, Inc

Sentinel Clinical Lab for Biothreat Agents 

The Holy Cross Hospital microbiology lab is also a certified Sentinel Clinical lab to assess suspected agents of bioterrorism, special pathogens, and emerging infectious diseases for their county [1]. The lab packages and ships potential and actual biothreat specimens to the Maryland State Laboratory for special pathogens, surveillance organisms (like COVID-19, Auris, CREs, and more). The lab offers guidance on what specimens to collect and how to collect them safely. The CDC states that Sentinel Laboratories “play a key role in the early detection of biological agents.”  

Partners with Automated Laboratory Team 

The lab is also PPE buddies for their Automated Laboratory Partners for routine testing for potentially infectious pathogens and Person Under Investigation (PUI) for a special pathogen. The PPE buddy system ensures that lab members look out for each other and follow all recommended safety protocols when dealing with infectious (or potentially infectious) pathogens. 

There is little room for error when dealing with infectious diseases, special pathogens, and potential biological threats. Early and accurate detection is critical to prevent or mitigate outbreaks and more widespread devastation.

Using GIDEON for Accurate and Timely Detection of Infectious Diseases and Biological Threats

“I rely on this program because it has everything I need in a pinch.” 

– Sheryl Stuckey

For Microbiology Labs

The Holy Cross Hospital Microbiology Lab appreciates the vast resources that GIDEON offers. GIDEON – the Global Infectious Diseases and Epidemiology Online Network – is a preferred partner for microbiology labs worldwide. 

About GIDEON, Sheryl states, “My favorite features are the organism identification function, information about diseases, comparison of organisms, and now the flowchart function.” She adds, “The system has been helpful in preparing continuing education for my team.  It helps us with unusual organisms and steering us toward possibilities when people have traveled or reside in other countries.”

Designed together with microbiology experts, GIDEON’s lab resources can help:

• Identify 2000+ pathogens with a few clicks,
• Generate a ranked pathogen probability list based on Bayesian analysis-based differential analysis,
• View detailed pathogen outbreak maps, and
• Elevate training to include dynamic step-by-step decision trees for unknown bacteria projects.

Image: GIDEON microbiology lab diagnosis probability engine and unknown pathogen decision tree. Copyright © GIDEON Informatics, Inc

For Physicians and Researchers 

An added bonus for hospitals, research hospitals, and teaching institutions is that GIDEON is the most comprehensive database of historical and current infectious disease outbreaks worldwide. Healthcare professionals and researchers can save a lot of time by using the GIDEON one-stop resource for infectious disease and epidemiology research. 

Conclusion

The GIDEON infectious disease database empowers microbiology labs, hospitals, physicians, and researchers to identify and detect pathogens early and more accurately. 

The platform hosts a wide variety of tools to help busy microbiology labs compare pathogens, analyze the epidemiological impact of patients’ travel histories, use probability engines and decision trees for pathogens and unknown bacteria, mycobacteria, and yeasts.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Listeriosis, Miscellaneous Intestinal Diseases, Non-Venereal Treponematoses, and more. Or check out our global status updates on countries like Montserrat, Portugal, Reunion, and more!

References

The post Microbiology Labs Can Detect Infectious Diseases. Here’s How. appeared first on GIDEON.

Of course, trends from past decades can be delightful when they return to inspire today’s music, fashion, and art. However, a dangerous blast from the past in the form of anthrax has reared its ugly head. In early August 2021, China reported a case of the deadly Anthrax pneumonia – its first case after ten years [1]. A few weeks later, local health authorities in another Chinese province discovered nine suspected cases of Anthrax [2]. Around the same time, Russia confirmed a case of Anthrax with a cutaneous infection in a patient involved in butchering cattle meat [3].  These particular anthrax outbreaks aren’t all the disease is known for; there are many ways that anthrax makes its way to the public eye, including popular culture or pop culture.

Bioterrorism and Hollywood seem to go hand-in-hand. Viruses and bacteria in biological weapons have infected the storylines of science-fiction movies and books for decades. From AIDS to Ebola to West Nile Virus, the United States has been obsessed with the concept of “killer germs.” After September 11, 2001, a new era of “killer germs” started making waves in modern pop culture. This is directly related to the “Anthrax by Mail” attack, which took place in the days and weeks following 9/11, which we will look at in more detail later. So, considering these events and the fascinations of our culture. Is it a surprise that so many movies, TV shows, and books show a distinct theme of disease apocalypse? Maybe not, but the real question then becomes, is this obsession and fear of an apocalypse by anthrax with good reason?

What is Anthrax?

The gram-positive bacteria Bacillus Anthracis causes anthrax; therefore, anthrax is also commonly known as B. anthracis. The bacterium gets its name from the Greek word for coal, “anthrakis,” because it often results in black lesions on the skin.  This bacterial rod is highly resistant to inactivation and is often present in the soil for decades. It most commonly affects agricultural animals such as sheep, cattle, and goats, but it can also infect humans.

One of the first reported anthrax cases dates back to the early 1800s, when an outbreak occurred in Italy. However, the disease is thought to have existed for centuries before this. Another early reported anthrax case dates back to 1876, when an outbreak occurred in wool mills in Yorkshire, England.

Luckily, the infection is not spread rapidly from person to person through the air like the flu or cold. It can, however, cause severe illness in domestic animals and humans if they interact with infected animals or contaminated animal products. There are three main types of anthrax: cutaneous, inhalation, and gastrointestinal.

Gastrointestinal

It is not as common as some other types of infection. Still, anthrax can also be found in the gastrointestinal system known as the esophagus, stomach, and intestines of someone who recently had raw or undercooked meat contaminated with B. anthracis. The bacteria that cause anthrax produce toxins that damage the lining of your stomach and intestine. This can lead to severe inflammation, bleeding, and even death.

Early symptoms of gastrointestinal anthrax include:

• nausea
• vomiting
• abdominal pain
• fever

As the disease progresses, you may experience:

• bloody diarrhea
• dehydration
• shock

–

Although gastrointestinal anthrax is rare, it can be fatal if left untreated. Treatment typically involves antibiotics and supportive care. With prompt treatment, the prognosis for patients with gastrointestinal anthrax is generally good.   In some cases, surgery may also be necessary to remove infected tissue.  Early diagnosis and treatment are essential for the best possible outcome. People can also become infected through contact with infected animal products, such as meat or hides.

Cutaneous

Cutaneous anthrax occurs when the bacteria enter through a break in the skin, usually via a cut or abrasion. The most common natural way people get a Bacillus Anthracis infection is cutaneous, after skin contact with contaminated meat, wool, or leather from infected animals. Cutaneous Anthrax infection can be transferred through open lesions from one person to another.

The initial symptom is usually a small, raised bump that resembles an insect bite. The bump develops into a blister that fills with pus and eventually ruptures within a few days, leaving an ulcer. Other symptoms may include:

• fever
• fatigue
• swollen lymph nodes
• Itchy blisters or bumps

–

In some cases, the lymph nodes may also be more severely affected. If left untreated, cutaneous anthrax can be deadly; however, prompt treatment usually effective.  Treatment typically involves antibiotics and supportive care. If you think you may have been exposed to anthrax, it is essential to seek medical treatment immediately.

Inhalational Anthrax

Inhalation anthrax occurs when people inhale airborne spores of the bacteria. This is the most severe and rare form of human anthrax, with a fatality rate of 80% and above. It is fatal unless treated immediately. Inhalation of Bacillus Anthracis spores is not common in nature. Anthrax spores can be released into the air and breathed in, causing the lungs to become inflamed. Symptoms of inhalation anthrax include:

• fever
• chest pain
• difficulty breathing
• coughing up blood
• dizziness 
• extreme fatigue

–

Like the other forms of the disease, inhalational anthrax can be fatal if left untreated. Early diagnosis and treatment are essential for the best possible outcome. Treatment typically involves a combination of antibiotics and supportive care. Anthrax is a rare but potentially deadly disease that should be taken seriously. If you think you may have been exposed to anthrax spores, seek medical attention immediately. Another unique aspect of this form is that this method has been exploited throughout history for bioterrorism purposes.

Bacillus Anthracis: A Dark History of Bioterrorism

Bacillus Anthracis is effective as a weapon primarily because of its spores. In nature, an infected host sheds the spores on the ground, which then multiply on contact with air. These spores can stay dormant for years, even decades, in the soil, waiting for another host [4]. The infection cycle then continues. However, when these microscopic spores can be aerosolized as sprays or powders, they can be released silently and escape detection. Even a small number of spores released in the air can infect massive numbers of people.

One of the most well-known instances of Anthrax used as a biothreat was in the United States. This instance is commonly known as the “Anthrax by Mail” attack, which took place in the days and weeks following 9/11. During this attack, a powder with anthrax spores was sent via the United States Postal Service to at least two senators and various news agencies across the East Coast. The powder allowed the spores’ easy inhalation, which mainly went unnoticed until the first anthrax diagnosis on October 4, 2001. By the end of the outbreak, 10,000 people had been at risk of exposure, 43 people had been confirmed to be exposed, 22 people were ill, and 5 of them had died. This attack, formally known as the Amerithrax attack, led to a long-term investigation that did not end until 2010. It is considered one of the most extensive and most complicated investigations in U.S. history. They found their suspect after conducting more than 10,000 interviews on many continents and collecting over 5,730 environmental samples. 

This is not the only time in which we’ve seen the diseases used in bioterror, in fact, it wasn’t even the first time. The earliest reports of weaponized deployment of anthrax come as early as 1914 during World War I. By 1960, there was serious concern about the possibility of anthrax as a bioterror agent. There was also concern about “lax” biosafety protocols in labs that handled dangerous agents like B. anthracis.

In 1979, one of the first globally reported outbreaks occurred in the USSR. This was a much larger Anthrax outbreak. Bacillus Anthracis spores were released from a Soviet military research center in Sverdlovsk, Russia. The story has all the intrigue and devastation characteristic of the Cold War. 60-70 people are estimated to have died from the accident, now termed the ‘Biological Chernobyl.’  Soviet officials at the time said the outbreak was due to naturally occurring anthrax and not concerning any use or study of biological weapons, however, many other officials around the globe felt this was an instance of bioterror that was covered up. It was only almost thirteen years later that a team of expert molecular biologists from Harvard University could investigate the spread of the spores on behalf of the CIA [5]. The team confirmed that aerosolized spores spread through the air and caused the outbreak, not meat.  The outbreak was made up of over 90 cases, primarily gastrointestinal.

A review of the GIDEON Bioterrorism note for Anthrax shows a long murky past of the pathogen being released by countries during the war, terrorists to spread fear and destruction, or by accident. 

Snippet of Bacillus Anthracis Bioterrorism Note from GIDEON database.

Anthrax Impacts Health on a Global Scale

Understanding the epidemiology, cross-border transmissions, and the history of this zoonotic pathogen is essential to help encourage safe practices when handling livestock and avert potential threats. Bacillus Anthracis infections have affected almost every corner of the globe. It is effortless for anyone to carry an infectious disease endemic to one country and spread it to others. Out of the 697 outbreaks that have been recorded, which can also be found in GIDEON, only ten have been cross-border events. So, when it comes to an anthrax outbreak, it is more likely to be related to naturally occurring anthrax from within its country of origin.

If we look even closer at the outbreaks, we can see that 91 countries have reported anthrax outbreaks. The European Region, as classified by the World Health Organization (WHO), has the highest amount of outbreaks while the Eastern Mediterranean Region has the lowest number. The European Region actually accounts for approximately 30% of all outbreaks globally despite the fact that India has the most outbreaks recorded by a single country. The year 2010 has the most recorded outbreaks with as many as 37 outbreaks occurring during the calendar year.

World map of Bacillus Anthracis outbreaks, 1770-2021

National public health agencies, frontline clinicians, infectious disease specialists, and microbiologists will have to work together to mitigate the effects of dangerous pathogens like the Bacillus Anthracis. Taking epidemiological data into account when diagnosing diseases in Point-of-Care settings can be a significant first step toward containing emerging infections. The United States, the U.K., E.U., and many other countries worldwide have implemented better tests and protocols around the way animals are handled. With these processes in place, cutaneous anthrax infections have significantly decreased.

The Vaccine

The anthrax vaccine was invented in 1881 by French chemist Louis Pasteur. It was the first vaccine ever created, and it was used to prevent anthrax infection in animals. The anthrax vaccine for humans was developed in 1954, and it is still used today. The vaccine is made from a killed form of anthrax bacteria. It is given in three doses over six weeks. It is injected into the skin or taken by mouth.

The anthrax vaccine is given to people at high risk for exposure to anthrax, such as people who work with animals or in laboratories. The anthrax vaccine is also given to military personnel and travelers. The anthrax vaccine is important because it can help in the prevention of anthrax infection. The vaccine is most effective when given before exposure to anthrax bacteria. However, it can also be given after exposure to help reduce the severity of symptoms. Like all diseases and disease control methods, prevention of the infection is the best medicine.

Should We Tremble in Fear of the Disease?

Anthrax as a bioterror agent has been a phenomenon that has spurred the imaginations of stories, films, and shows for decades. This project set out to determine if this is all hype around something improbable or if our morbid obsession with “killer germs” is founded in reality.

From a sample of 697 reported outbreaks spanning across the globe, it seems that the morbid curiosity is more founded in sensationalism than reality itself. There have only been three outbreaks reported due to bioterrorism-related events, which translates to 0.43% of all anthrax outbreaks. Not only that, but the statistical analysis shows that there is not a significant difference between the bioterror events across the world regions. This means that no one area of the world is statistically more likely than another to have a bioterror event related to anthrax based on this historical data alone.

The question remaining is whether we will see the killer germs like anthrax and Ebola continue to dominate pop culture, or will coronaviruses and the like take the mantle of Hollywood’s favorite doomsday germ after the pandemic?

The GIDEON Difference in Medical Research

GIDEON is one of the most well-known and comprehensive global health databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical and health professionals and researchers access to a continuous stream of health data. Whether your research involves quantifying health data specifically for disease control, learning about specific microbes, or testing out medical differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our health based eBooks that feature medical notes on Loiasis, Miscellaneous Intestinal Protozoa, Onchocerciasis, etc. Or check out our global health status updates on countries like Morocco, Romania, Saint Kitts and Nevis, and more!

References 

1. “China Reports First Human Case of Pulmonary Anthrax in 10 Years,” Caixinglobal.com. [Online] [Accessed: 26-Aug-2021].
2. Global Times, “Shanxi Province reports 9 suspected anthrax cases, treatment underway,” Globaltimes.cn. [Online] [Accessed: 26-Aug-2021].
3. Press Release, “Human anthrax case reported in Karabudakhkent region, Russia,” Outbreaknewstoday.com, 10-Aug-2021. [Online] [Accessed: 26-Aug-2021].
4. A. Chateau, S. Van der Verren, H. Remaut, and A. Fioravanti, “The Bacillus anthracis Cell Envelope: Composition, Physiological Role, and Clinical Relevance”, Microorganisms, vol. 8, no. 12, p. 1864, 2020. Available: 10.3390/microorganisms8121864 [Accessed 26 August 2021].
5. “Anthrax at Sverdlovsk, 1979“, Nsarchive2.gwu.edu, 2017. [Online] [Accessed: 26- Aug- 2021].
6. Epidemic entertainments: Disease and popular. – JSTOR. JSTOR. [Online][Accessed: 6-Dec-2021]
7. History of anthrax. Centers for Disease Control and Prevention. [Online][Accessed: 6-Dec-2021]
8. Amerithrax or anthrax investigation. FBI. [Online][Accessed: 6-Dec-2021]
9. Anthrax – biological threat in the 21(st) Century. [Online][Accessed: 6-Dec-2021]
10. Anthrax: A disease of biowarfare and public health importance. World journal of clinical cases. [Online][Accessed: 6-Dec-2021].
11. World Health Organization, Fourth edition anthrax – world health organization. [Online][Accessed: 6-Dec-2021].

The post Anthrax: All You Need to Know About Bacillus Anthracis appeared first on GIDEON.

Bacterial Unknown Project. Original Photo by CDC on Unsplash

Fast, Online Flowcharts for a Bacterial Unknown Project

GIDEON’s Bacterial Unknowns Project allows microbiology professors to make and print dynamic dichotomous keys online. Using hundreds of decision trees, you can help your students identify over 2,000 pathogens with a few clicks of your mouse. That’s right. No more drawing elaborate dichotomous key flowcharts by hand or using a clunky word processing program.

GIDEON is one of the most well-known reference databases for infectious diseases and a trusted partner for clinicians and microbiologists worldwide. Together with microbiology professors, GIDEON designed an interactive decision tree tool to help identify bacteria, mycobacteria, and yeasts.

Sample screenshots of GIDEON Unknown Bacteria Project, decision tree.

A review from a satisfied customer:

“I was given 2 weeks to prepare the syllabus for two courses I needed to run in the fall semester, one in Public Health and the other in Pathogenic Microbiology. GIDEON was the perfect tool to build activities and learning around it made my job much easier!”

University of South Florida, Dr. Johnny El-Rady, Instructor (Microbiology and Genetics)

Professors agree that bacterial unknown projects are the ultimate test of a student’s understanding of pathogens in the classroom. Testing students with “mystery” bacteria allows them to combine their knowledge of pathogen molecular structures and biochemistry with essential laboratory techniques required to identify them.

However, these professors are also unanimous in accepting that preparing dichotomous keys for each class and semester can take time. As a result, students may attempt these active learning tests to identify microbes only once or twice in a semester.

Why Do Students Need to Identify Unknown Bacteria in Their Microbiology Studies?

Learning through the Unknown Bacteria Project is a great way for students to get ready for the real world. After all, professionals in the laboratory are counted upon to identify or confirm the presence of pathogens from an unknown organism. This expertise is essential whether in a hospital, clinic, or academic research lab. Working knowledge of fundamental laboratory techniques, conducting aseptic transfers, preparing media, and following a systematic flowchart to perform differential testing are invaluable skills.

For example, studying the science of pathogens for further research involves isolating and developing pure colonies to study. This step is critical to make sure the result of further testing is accurate, but new students may find this step difficult and need to practice. This is relevant even though labs are getting more automated than before. To be a professional writer, you have to know the basics of grammar and not rely entirely on auto-correct. Professional musicians need to understand how music notes work together in harmony, even if the software is available to help create music.

Knowing how to perform laboratory techniques correctly will help students identify pathogens in imperfect situations and troubleshoot when things go wrong. Bacterial Unknown Projects are also significant learning assignments because students learn to record and organize their data appropriately, work with their peers, and present their reasoning in written reports. These skills are priceless in a professional setting, private or academic, where we are often asked to defend or explain our work to other teams.

However, since 2020, the learning environment across the globe has changed considerably. Professors have been facing challenges when it comes to administering Unknown Bacteria Projects online.

How to Conduct Bacterial Unknown Projects Online Without a Lab?

The COVID-19 pandemic inserted a bit of a nonsense mutation in the lives of many microbiology professors. With so much uncertainty, lockdowns, and other restrictions, academic instruction went online. Didactic courses were easier to convert into an online format, but how do unknown projects translate to remote learning? After all, the very point of an unknown bacteria activity is to train students in a hands-on setting for wet lab techniques.

The Department of Molecular Biosciences at the University of Kansas at Lawrence published their experience in the Journal of Microbiology and Biology Education, March 2021. After administering a test to identify an unknown microbe for about 50 students, they conducted a survey and collected anonymous responses. 80% of students surveyed reported the online bacterial unknown project successful in increasing their skills. The project took over three weeks, with the last week to prepare for oral presentations.

Evaluations focused more on effective student collaborations, arriving at the correct result by asking for the right virtual “tests,” peer evaluations, and communicating their findings in an oral presentation instead of a written report. The entire project was done using images of stains. The paper discusses how delivering unknown projects online is not a substitute for wet lab experiences but a complementary teaching method.

Tighter budgets for lab equipment and resources means often having to test students on a limited range of bacteria for in-person wet-lab testing. Creating dynamic dichotomous keys online can help students identify pathogens that are important to learn about but may not be possible to administer in a teaching laboratory.

Using GIDEON’s Bacterial Unknown Decision Trees for Laboratory and Remote Learning

GIDEON’s decision trees for bacterial unknown projects are designed with busy microbiology professors in mind.

Create a dichotomous key in just 3 steps:

Step 1: Specify whether you want to identify a bacteria, mycobacteria, or yeast.

Step 2: If identifying bacteria, select: the gram reaction (gram-positive bacteria or gram-negative bacteria), bacterial shape (gram-negative rods, gram-positive rods, and more), respiration, and other lab tests (like negative urea test, blood work) by following the intuitive flowchart.

Step 3: Print your key, or export and share with your peers. It’s that simple.

The example below shows the flowchart for Bacillus Subtilis. On the right, you also get a list of the most probable bacteria based on your selections.

Dichotomous key for Bacillus Subtilis. Screenshot from GIDEON’s Bacterial Unknown Decision Tree.

Conclusion

Unknown Bacteria Project is considered to be one of the most effective ways to learn. Students apply their theoretical knowledge of molecular structure, biochemistry, and lab techniques in a practical wet lab setting. However, the process of preparing dichotomous keys for each test is cumbersome. Professors who are pressed for time find it challenging to draw decision trees by hand or use a word processing program.

Additionally, when the COVID-19 pandemic began, remote learning became the new normal. While adapting all courses to an online format can be hard, making Unknown Bacteria Projects applicable for remote learning is much trickier. Dynamic, online flowcharts and decision trees can help professors teach their students more effectively in online and wet laboratory settings.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Miscellaneous Intestinal Trematodes, Orbital and Eye Infections, Paragonimiasis, and more. Or check out our global status updates on countries like Rwanda, Saint Lucia, Antilles, and more!

The post Unknown Bacteria Projects: Hundreds of Easy Dichotomous Keys for Microbiology Courses appeared first on GIDEON.

“Should I get the COVID-19 vaccine even if I had COVID?” The answer is yes. Getting COVID-19 in the past is not a guarantee against reinfection.

An August 2021 study out of Kentucky, USA, studied hundreds of residents and found that unvaccinated survivors of COVID-19 had more than double the risk of getting reinfected with COVID-19 compared to the vaccinated group of people. Public health officials, medical professionals, and infectious disease experts worldwide continue to urge more people to get vaccinated as soon as possible. But some individuals who recovered from COVID-19 want to know why.

Wearing safety gear during on-ground combat will not prevent all adverse events. The gear is designed to prioritize and protect a soldier’s brain, heart, spine, and other vital organs from damage. The vaccines are meant to work the same way.

To those on the fence, the decision to get vaccinated or not requires more information. Queries from unvaccinated COVID-19 survivors include:

• If you already had COVID-19, why are you not protected for life against the virus? After all, with a chickenpox infection, you get lifelong immunity.
• If people who are vaccinated can still get infected with the Delta variant, why do we need the vaccine?
• COVID-19 vaccines are currently approved for emergency use. Is this safe?
• Which COVID-19 vaccine offers maximum protection against COVID-19 and variants like Delta?

Here are answers to these questions to help you choose.

Natural Immunity After COVID-19 Varies Widely from Person to Person. Vaccine Immunity is More Consistent.

Natural immunity from a COVID-19 infection is expected to last 90 days or more in most people. However, the strength of resistance built against COVID-19 varies widely from person to person. It is based on many factors, including viral load (the amount of virus in an infected person’s blood). People who had a light viral load the first time around may not be protected against reinfection. On the other hand, our immune response to the COVID-19 vaccine is more consistent. This is why you are encouraged to get vaccinated even if you had COVID-19.

Different pathogens trigger unique immune responses. The chickenpox virus (Varicella zoster) triggers the production of antibodies with lifelong memories that protect us against reinfection. COVID-19 is new, and so far, there is no data to suggest it offers immunity for life. With the COVID-19 mRNA vaccines, your body gets exposed to a harmless piece of the COVID-19 virus, the spike protein, which is just enough to train our immune system to learn how to fight this particular pathogen.

And for those previously infected with COVID-19, the vaccine can act as added protection, which is necessary to fight emerging variants.

The Delta Variant is a Different Beast; Natural Immunity Needs All the Help it Can Get.

The B.1.617.2 variant, or Delta, is significantly more contagious than the original COVID-19 virus from 2020 and all other existing variants. It is also more likely to cause severe disease and death by breaking through our natural immunity and even vaccine-related protections. This applies even if you recovered from COVID-19 in the past.

With the original COVID-19, symptoms took 7 to 14 days to appear. The Delta variant launches its attack on our body much faster. Symptoms could appear within two to three days – which means our immune system has less time to prepare. Additionally, people infected with the Delta variant carry 1000 times more viruses than the original COVID-19. The vaccines can boost our natural immunity to strengthen our resistance against the new COVID-19 variants, including the insidious Delta.

It is important to note that the COVID-19 vaccines have proven effective at protecting against severe illness and death. It is still possible to get infected after being vaccinated. But if you are vaccinated, you will most likely experience milder symptoms without extreme damage to your lungs and other organs. In the United States, 97% of hospitalizations from Delta and 99% of associated deaths are due to unvaccinated individuals. These percentages are based on data from January to June and will be updated based on the impact of Delta.

Keep in mind that you are considered fully vaccinated two weeks after your second dose for two-dose vaccines or after one shot for a single-dose vaccine. Even after getting vaccinated, it is advisable to continue following recommended safety protocols.

According to Stephen Berger MD, an experienced doctor, war veteran, and infectious disease specialist, “Those that get vaccinated and then catch an infection, like the Delta variant, may have not yet formed antibodies.” Dr. Berger further stated, “People should still take the usual precautions and wear masks, sanitize their hands, and practice social distancing to help limit the spread of the virus.”

It’s like sending soldiers into battle. The process involves intense preparation and strategy beforehand. However, even the most experienced veteran returning to the call of duty requires armor, like helmets and bulletproof vests, and is trained to follow standard safety measures. The reason for this is because war brings a great deal of uncertainty and high mortality risk. Wearing safety gear during on-ground combat will not prevent all adverse events. The gear is designed to prioritize and protect a soldier’s brain, heart, spine, and other vital organs from damage. The vaccines are meant to work the same way.

The Delta variant may be dashing the world’s hope of reaching herd immunity since vaccinated individuals can spread the virus as much as the uninfected.

This insight makes it more urgent for each individual to get vaccinated and not count on herd immunity or immunity from prior infections to protect them. Professor Sir Andrew Pollard of the Oxford Vaccine Group recently informed that COVID is not like measles where if 95% of the population is vaccinated, the rest are protected. He stated, “…anyone still uninfected at some point will meet the virus.”

Meanwhile, the death knell from COVID-19 and the Delta variant continues to sound.

As of August 10^th, 2021, more than 4.3 Million COVID-19-related deaths have been reported to the World Health Organization (WHO). The United States is in the lead with 600,000, followed by 563,000 in Brazil, and over 428,000 in India. In the United States, with only 50% of the population vaccinated, the daily case count now stands at 100,000 and is expected to grow. According to the CDC, the Delta variant is now the cause of 83% of all new cases in the U.S.

While the U.K. reported the highest single-day deaths from COVID-19 on August 11^th, 2021 (their highest since March as a result of cases from July), hospitalizations, ICU admissions, and deaths were much lower in this wave than at the beginning of the year. Over 75% of adults in Britain have been fully vaccinated, and 89% have received at least one dose.

In the United States, while the COVID-19 vaccines are under evaluation for safety and efficacy, several have been approved for emergency use.

Are Vaccines Approved Under EUA or Emergency Use Authorization Safe?

Several countries have granted preliminary approvals for vaccines in light of the devastation caused by COVID-19 and its variants. In the United States, vaccines by Pfizer-BioNTech, Moderna, and Johnson & Johnson (J&J) received EUA approval. Seeing that it is the first time vaccines are being granted EUAs, how effective are the vaccines?

In an ideal world, there would be long-term data and lots of time to analyze and decide whether to get vaccinated. In the future, COVID-19 vaccines like the chickenpox and flu vaccine, are available for those who need it but are “not necessary”. But right now, like medics on a battlefield, the biggest concern is to stop the bleeding. In the case of COVID-19 and its variants, it means minimizing hospitalizations due to severe illness and deaths. The three vaccines authorized under EUA in the U.S have proven effective against moderate to severe symptomatic disease.

While the EUA is a temporary fast-tracking of potentially life-saving drugs or therapy, it is not granted without reviewing detailed submissions from vaccine manufacturers containing proof of safety and data from clinical trials on more than thousands of willing participants. Another reason for the rapid FDA review and response is that the COVID-19 pandemic is the highest priority. So, resources to evaluate COVID-19 vaccines have been diverted accordingly.

In short, natural immunity will not last forever, the Delta variant is much more capable of breaking through natural immunity, and unvaccinated COVID-19 survivors have a higher likelihood of getting reinfected. If you choose to get vaccinated, here is a comparison of the reported COVID-19 vaccine efficacy against the Delta variant.

Comparison of COVID-19 Vaccine Protection Against the Delta Variant

1.    Moderna:

The Moderna vaccine is a two-dose vaccine, taken 28 days apart. It is an mRNA vaccine that makes the spike protein and teaches our body to create antibodies.

Effectiveness against Delta variant:

• Two doses: 94-95% effective against the Delta variant [1] [2].
• Single-dose: 72% effective.

2.   Pfizer-BioNTech

The Pfizer-BioNTech vaccine is a two-dose vaccine taken 21 days apart. It is also an mRNA vaccine that makes the spike protein.

Effectiveness against Delta variant:

Reports vary between 79 – 95% so let us break them down:

• A UK study demonstrates 88% overall effectiveness and 96% against hospitalization[3].
• A Scotland study reported 79% effectiveness [4].
• A study out of Canada showed 87% effectiveness [1].
• A study out of Israel showed 90% effectiveness initially but more recently reported 41% effectiveness against symptomatic infections, but 91% effective against severe disease and 88% against hospitalization [5]. A report by the Ministry of Health, Israel, studying confirmed COVID-19 cases from January-July 2021, also showed that vaccinated individuals with pre-existing conditions are better protected against serious illness compared to non-vaccinated individuals without any risk factors [6].
• A study from France reported 94% overall effectiveness with two doses [7].
• A New York study stated 94-95% overall effectiveness [2].

3.   Johnson & Johnson – Janssen

The J&J Janssen vaccine is a viral vector vaccine, which uses inactivated and modified Adenovirus as a ‘Trojan horse’ to deliver the gene that encodes the SARS-CoV-2 spike protein. A well-known Bacillus Calmette Guerin (BCG) vaccine works the same way. The vaccine differs from other vaccines on the market in that it requires only one dose.

Effectiveness against Delta variant:

• 9% efficacy in preventing moderate to severe disease. However, the study is small, and some experts now believe a booster may be required [2].

4.   AstraZeneca-Oxford (No EUA in the United States)

The AstraZeneca-Oxford vaccine, similar to the J&J Janssen vaccine, also works as a ‘Trojan Horse’ carrying valuable information to help train our immune system. The AstraZeneca vaccine requires two doses, taken 30 days apart.

Effectiveness against Delta variant:

• The Public Health England study reported 79% overall effectiveness and 96% effective against severe disease[3].

Immunity to COVID Can be Tricky

All around the world, we are waging war against the COVID-19 virus and its variants. The Delta variant is the most dangerous and highly contagious of all emerging variants. Compared to the original COVID-19 and all its other variants, infection due to the Delta is most likely to result in death and severe illness.

Natural immunity gathered from a previous COVID-19 infection is not reliable protection from the Delta. Unvaccinated COVID-19 survivors have double the risk of being reinfected versus vaccinated COVID-19 survivors.

The bottom line is that regardless of the brand or type of vaccine you choose, experts recommend that you get fully vaccinated to protect yourself and your loved ones – even if you had COVID-19 in the past.

References

The post COVID-19 Vaccine: Do You Need It Even After Surviving COVID-19? appeared first on GIDEON.

Image: Flying Pipistrelle bat (Pipistrellus pipistrellus) in the wooden attic of a city church. This species is known for roosting and living in urban areas in Europe and Asia.

Nipah virus (NiV) has been detected in several species of bats. While the Pteropus genus of bats has been the reservoir for NiV, new research from Gokhale et al. identified potential NiV infection in Rousettus leschenaultii and Pipistrellus pipistrellus bats in India [1].

Why is this significant?

In the past, the bat-borne Nipah virus has not raised much concern in the West –  since its discovery in the late nineties, outbreaks have been limited to Southeast Asia. However, NiV mutations, zoonotic spillovers, the effects of deforestation, and other factors signify a growing potential for NiV to spread. 

People think of these bat-borne viruses as exotic diseases that are far away. The COVID-19 pandemic illustrates, however, that local spillover of novel viruses can affect the whole world. 

– Stanford epidemiologist Stephen Luby, MD

Additionally, while NiV transmission was previously assumed to be annual or seasonal (primarily winter), a multi-disciplinary study based on six years of data indicates otherwise. Researchers from Stanford, Columbia, Johns Hopkins, and other global partners suggest that bat immunity levels drive NiV infections and that infected bats can shed the virus at any time of year [2].  This article was published in PNAS (Proceedings of the National Academy of Sciences of the United States) and edited by Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases.

This growing body of Nipah virus research is a bat signal urging the world to pay attention.

The World Health Organization (WHO) prioritized the Nipah virus on their list of epidemic threats that require urgent action. The US National Institutes of Allergy and Infectious Diseases categorizes Nipah at Category C:  “emerging pathogens that could be mass engineered for mass dissemination in the future.” Some governments consider the Nipah virus as a potential agent of bioterrorism and strictly regulate laboratory testing. Several other studies suggest that the NIV virus is a potential pandemic agent [3].

We must track Nipah like a parent that monitors an eight-year-old child in a playground. We do not have to divert all attention and resources urgently, but our eyes and ears need to “stay wide open” for potential issues.

Although NiV is a paramyxovirus – agents primarily responsible for acute respiratory diseases –  transmission from human to human is currently low. The R0 (the number of cases that result from an infected patient) is only 0.48. In comparison, the R0 for SARS-CoV-2 Delta Variant is 5-8, SARS-CoV-2 is 2.5-5.7, SARS-CoV is 2.4, and MERS is 1. Reported case mortality is high at 40 – 70% and is the reason why NiV has not caused mass transmission in a population:  many die before they transmit the disease. Another factor preventing larger outbreaks is that the virus has been detected in villages with a relatively low population density.

But changes are brewing, and we need to track the Nipah virus more closely than before. 

Reasons to Track Nipah Virus Infection (NiV)

1. New Nipah virus mutations and their impact on health

With Nipah, there is no cause for panic just yet. Currently, only a small percentage of infected people transmit NiV. But super-spreaders can infect their loved ones, caregivers, healthcare workers, and others in their community. The incubation period is 5-to-14 days, but in a severe case, it has been reported to extend up to 45 days – sufficient time for an infected person to transmit the virus.

Any type of Nipah virus outbreak has been confined mainly to Southeast Asian countries with outbreaks in Bangladesh, India, the Philippines, and Malaysia. Still, as new strains continue to be detected, the threat level that NIV poses can potentially escalate. More research is needed in this field, but two distinct strains have been detected – Bangladeshi and Malaysian [2].

Image: Nipah virus global outbreaks map, 1998 – 2019. Copyright © GIDEON Informatics, Inc.

Consider another bat-borne disease: COVID-19. Since the start of the pandemic, SARS-CoV-2 has mutated quite rapidly. As you read this, variants such as ‘Delta’ (B.1.617.2) continue to wreak global havoc. WHO now categorizes these “mutants” as ‘Variants of Concern’ (VOC) and ‘Variants of Interest’ (VOI).

One concern is that the NIV receptor in humans is ephrin – found in all tissues. As such, infection by a more potent mutant could affect every organ in our body, including our blood and the central nervous system.

2. Potential Zoonotic Spillover: COVID-19 Pandemic Precedent?

As we saw with COVID-19, the spread from a bat to a pangolin and between humans happened extremely rapidly.

NiV was first discovered in pigs but is widely found in bats (Pteropus genus). There is also spillover to horses and other domestic animals. Nikolay et al. report that multiple Nipah spillover events from bats to humans occur in Bangladesh when humans consume raw fermented date palm sap contaminated by infected fruit bats [4]. Another reason for concern is that the Pteropus group of bats is found all over Asia and Australia. If more spillovers continue to occur, the world’s Nipah virus problem may increase quickly [2]. And as discovered in India (and always suspected by NiV experts), more bat species may be infected with NiV [1].

Stanford epidemiologist Stephen Luby MD stated about the Nipah virus, “People think of these bat-borne viruses as exotic diseases that are far away. The COVID-19 pandemic illustrates, however, that local spillover of novel viruses can affect the whole world.”

NiV and SARS-CoV-2 have similarities: both are bat-borne RNA viruses, demonstrate zoonotic spillovers, and cause acute respiratory distress – and without proper medical intervention, can be fatal. Differences include a slower rate of transmission for Nipah versus COVID-19 and its variants, for now. 

Image: Comparison between Nipah virus and COVID-19. Copyright © GIDEON Informatics, Inc.

3. Nipah Virus can be transmitted continually

One of the most valuable insights from the Epstein et al. PNAS study was that bats do not transmit NiV annually or seasonally. Instead, there are multi-year cycles of transmission across bat species, which can increase the risk to humans.

Additionally, the study found that the Nipah virus in bats can recrudesce or reinfect the same bat. If an infected bat has high levels of immunity against NIV, it may not shed or transmit the virus. But when immunity levels are low, the same bat may start shedding the virus – even after years! If the immunity of a group of bats drops, an infected bat that immigrates to the flock could reinfect the group. Also, if one bat is persistently infected through recrudescence, NiV may be reintroduced into the bat colony [2].  

4. Ecological Changes Driving Closer Bat-Human Interactions and Infection

Generally, most animals prefer to stay away from humans. This is true unless their survival is linked to living closer to humans. In the case of Nipah, the Pteropus medius bat (the predominant host) travels short distances and likes to stay close to home. They pick their homes based on the availability of food in high human population density areas. In Bangladesh, they prefer to live close to humans because of more farmland and the greater availability of silver date palm trees. In Malaysia, fruit trees were planted close to piggeries, which, in turn, are within the range of human habitation. The United Nations projects that by 2050, 60% of the world’s population (4.9 billion people) will live in urban areas, increasing the risk of zoonotic spillovers. Most of this urbanization will occur in Asia and Africa.

Bat feces, called guano, is used as fertilizer in Thailand and Cambodia, and selling it is lucrative. Some people in these areas often encourage fruit bats to live close by for easier access to the droppings.

Deforestation is another strong influencer. Some research suggests that bats shed more viruses under stress [6]. Bat populations undergo stressful environmental events such as human encroachment, deforestation, and fires that cause them to flee their natural habitats, searching for new ones. Many of them choose to “cut out the middleman” and roost directly on fruit trees, often planted close to humans and other domesticated or farm animals. 

Image: Deforestation. Photo by Souro Souvik on Unsplash

Additionally, bats, including Pteropus medius, are gregarious and social animals. Living in a large roost also offers them greater protection from other predators. Pteropus Medius bats prefer to create large roosts in tall trees. But with deforestation on the rise, these bats have been forced to form smaller populations in other locations [7].

Image: Nipah virus infection summary. Copyright © GIDEON Informatics, Inc.

Nipah infections are characterized by encephalitis and acute respiratory distress, which are incredibly difficult to treat [5]. The mortality rate is at 40-70%. Since it is found in rural areas with limited lab testing resources and awareness, early detection is often not possible. There are no licensed treatments for Nipah virus infection though some monoclonal antibody therapies are being evaluated. Additionally, there is no vaccine against this virus. According to GAVI, the global vaccine alliance, phase 1 clinical trials are underway.

With COVID-19 being a global public health crisis, investments in vaccine R&D and production have been high from the get-go. But the same mRNA vaccine technology may also be useful in preventing NiV infections.

Conclusion: Nipah Virus Outbreak and Disease

Nipah virus has been around for 20 years and persists without a vaccine or licensed drug treatment. Though transmission rates are low, mortality rates are high.

The virus has much in common with SARS-COV-2. In particular, both are bat-borne, RNA-based viruses that have spilled over to other animals and humans. The virus of COVID-19, mutating much more often, has spread to every corner of our globe in a full-blown pandemic.

Variant strains of the Nipah virus have been detected. New research also identified more species of bats infected with the NiV virus. Preventing the next pandemic involves equipping researchers and clinicians on the frontlines of emerging disease prevention with the right epidemiological, diagnostic, therapeutic, and preventive tools, right off the bat. 

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global disease databases for infectious diseases and its information can be invaluable for disease prevention. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

References

The post Nipah Virus Outbreaks: New Reasons Why the West Needs to Start Caring appeared first on GIDEON.

EXCLUSIVE SNEAK PEEK FOR EXISTING GIDEON CUSTOMERS

• All existing GIDEON customers get early access to experience and test the GIDEON R Beta package. Click here to download the package.
• Let us know what you think! 
• Your comments help us refine and launch the best version of GIDEON R for your research needs.

Image: GIDEON R package in use

Over 189 scientific studies that leveraged GIDEON’s software were published in just the past three years. This number is rapidly growing as many investigators turn to the extensive infectious disease library for epidemiological insights and cross-discipline studies. 

The GIDEON database is a valuable web-based reference of infectious diseases and their global occurrences since the 1900s. As of 2020, researchers also get to customize and build their statistical tools to analyze data using the GIDEON API or Application Programming Interface (API). 

While GIDEON’s massive global database of infectious diseases and the GIDEON API are potent tools with a variety of functions, GIDEON R allows you to boost your analytics to the next level. 

Why Use GIDEON R For Data Analysis?

R, the free, open-source programming language for statistical analysis software, has transformed how investigators prep, clean, and wrangle large databases to get good information. With minimal coding required, you can clean and set up faster and conduct reproducible steps during statistical analysis. 

R is quickly gaining in popularity with researchers. R programming is a part of the standard analytics curriculum in universities like Harvard and the Imperial College in London. It is fast becoming a mainstay in Public Health and epidemiological research studies and reports. In the UK, the O Health foundation, an independent charity, developed an NHS-R community to help leverage the power of R for the NHS (National Health System). Teams of experts trained NHS analysts to use and embed R into the NHS to help improve the delivery of care.  

Using the GIDEON R package brings you more efficiency to:

• Investigate 25,000+ ongoing and historical infectious disease outbreaks,
• Produce granular outbreak maps for chosen diseases in a given year range
• Investigate the emergence of zoonotic diseases in a particular country,   
• Evaluate epidemiological situations around the globe, 
• Retrieve a wealth of information on 360+ infectious diseases, 2,000+ pathogens, and 30,000+ trade names of drugs and vaccines.

The GIDEON R package brings all the convenience and efficiency of the free, open-source programming language R to the world of epidemiology. 

Benefits of using GIDEON R include…

• Simplicity: 

There is no need to learn how to work with a REST API client to parse the GIDEON database. With GIDEON R, you can hit the ground running and start crunching your data. 

Working with a GIDEON REST API offers you greater and complete control over how your program manipulates data. However, it requires users to possess programming skills and may also mean an investment in rigorous manual and automatic testing to ensure it functions well under pressure. Your team will need to spend considerable time testing, sequencing API calls correctly, validating parameters, and fixing any other issues before beginning the analysis. GIDEON R gives researchers familiar with R the ability to skip this part of the process and get straight to the analytics.  

• Reproducibility: 

GIDEON R allows you to create scripts for your entire analysis process and run a simulation. This way, even if you make a mild edit to the data, the whole process can be run again with the reassurance of reproducibility. As an investigator, you can then focus on developing and analyzing different runs without worrying about the analytical or statistical method changing. 

• Flexibility

Epidemiology research is complex and challenging. No two studies will ever be precisely the same. R offers a considerable toolkit of statistical modeling tools that epidemiologists require, including logistic and Poisson regression and Cox proportional hazard models. 

• Better Visualization

With R, stats come to life. Using R for visualization is like the famous scene in the classic movie ‘The Wizard of Oz’ when Dorothy steps out of her dull black and white house and into the dazzling technicolor land of Oz. 

R can create any type of graph or charts – fast ones for analysis and even publication-ready charts with minimum code. R offers in-built functions and libraries to generate basic maps like bar charts, histograms, and scatter plots. It can also create advanced visualization tools like heat and mosaic maps, 3D graphs, or correlograms in vivid technicolor for your exploratory data analysis, presentations, and publications.

• Compatibility

R runs on everything. R’s code is platform-independent – which means it does not matter if you use Windows, Mac, or any other system. So, with GIDEON R, you can be sure that your program is compatible with any type of platform you or your team use. This is a significant benefit when working with teams located in different regions and across the globe. 

GIDEON R optimizes how investigators use the GIDEON API to mine the GIDEON infectious disease database. 

GIDEON API

The GIDEON API allows medical professionals and researchers pressed for time and resources access to global data on hundreds of diseases, drugs, and bacteria – since 1348 AD. 

With the GIDEON API, you get a direct feed of infectious disease data from around the world at your fingertips. The GIDEON API is based on RESTful principles, and data is refreshed and updated every day, sometimes even multiple times a day. 

The best part? All institutional subscribers to GIDEON get access to the GIDEON API free of charge. 

Published Articles that Used GIDEON Software for Epidemiology

According to Professor Rodolphe Desbordes, Professor of Economics at SKEMA Business School, France, and widely published in International Economics and Economic Development: 

“GIDEON was the perfect database for the epidemiological project I had in mind <…> the information provided on each disease was crucial to a better understanding of disease-specific characteristics.“

 

GIDEON has a rich history of partnering with researchers and scientists worldwide by offering a wide variety of resources on infectious diseases. You can find data going back to 1348 AD, track outbreaks on an interactive map, identify over 2000+ pathogens, diagnose and compare any number of infectious diseases, drugs, and microbes. 

The GIDEON database contains 23,600 country-specific notes with 3+ million words of text that outline the status of specific infections within each country. Also featured are over 250,000 linked references, 3,000 images, 34,000 graphs, and numerous interactive maps. 

There are more than 189 studies published in just the past three years that use GIDEON’s database to generate meaningful insights. Here are a few of the recent articles published that used GIDEON for their research: 

• June 2021, Dengue: Alisa Aliaga-Samanez et al. from Spain published the first high-resolution analysis of biogeographic changes in dengue transmission risk. The study informs about the Dengue virus (DENV) making a home in previously low-risk areas and urges the global public health community to implement preventive measures [1]. 

• June 2021, Foodborne Parasitic Diseases: F. Chavez-Ruvalcaba et al. published their review of foodborne parasitic diseases in the neotropics. Since more than one-fifth of the world’s population is infected by one or more intestinal parasites, the authors review the most common ones affecting countries in Central and South America [2]. 

• June 2021, Lyme Borreliosis in Poland: Brzozowska et al. published their study about the tick-borne Lyme Borreliosis in Poland. They found the incidence to be equally significant in urban and rural communities and stressed the importance of widespread awareness and education. The study used GIDEON-generated data to compare Lyme Borreliosis prevalence across the globe [3].  

• May 2021, Control of Intestinal Nematodes in African Green Monkeys (AGMs): A veterinary study by Katalina Cruz et al. tackled the efficacy of antiparasitic treatment and husbandry methods to control nematode infections in AGMs. The authors referred to insights from the GIDEON database to highlight that because AGMs regularly come in contact with humans on the island, they may play a role in the zoonotic parasitic infections commonly found on St. Kitts [4]. 

• May 2021, Emerging Antibiotic-Resistant Pathogens in Iran: As part of their study, Rahder et al. analyzed the reported prevalence of actinomycetes infections worldwide using published global prevalence data sourced from the GIDEON database. They identify infections in Iran affecting immunocompromised and other vulnerable patients and recommend continuous monitoring to better prevent infection and improve therapeutic methods to treat the infections [5]. 

• March 2021, Brucellosis: Battikh et al. from Tunisia used the GIDEON database to analyze the rise in Brucellosis cases in their hospital. They found that osteoarticular involvement was the most common complication of brucellosis in their patient pool. The researchers recommended better animal control practices through vaccinations, occupational and personal hygiene, farm sanitation, and more to lower the number of cases [6]. 

• March 2021, Global Empirical Assessment of Spatial Dynamics of Major Disease Outbreaks: Professor Rodolphe Desbordes presented the Spatio-temporal dependence and mortality consequences of the top 15 disease outbreaks in developed or developing countries over ten years. In the article, he states that his team mainly relied on the “under-exploited GIDEON database that provides a worldwide coverage of all infectious diseases [7].”
  
  In an interview, Professor Desbordes talked about why having access to data added to his study. He mentioned, “As an applied economist, I value excellent data on a novel and interesting issue more than anything else. The GIDEON database allowed me to publish in an excellent journal and, most importantly, carefully model the spatial diffusion of infectious diseases in a globalized world.”

• March 2021, Ecological Conditions That Increase Vector-Borne and Zoonotic Diseases Outbreaks: Morand and Lajaunie published their findings on how global forest cover changes and oil palm expansions are associated with increased outbreaks of vector-borne and zoonotic disease outbreaks from 1990 to 2016. The authors state, “Here, we examine the global trends between changes in forest cover in recent decades and epidemics of human infectious diseases, using the GIDEON global database, which is the best available dataset on infectious diseases that has already been used in several studies [8].”

Want to be an early user and test GIDEON R?

• All existing GIDEON customers get free access to experience and test the GIDEON R Beta package. Click here to start.
• Let us know what you think! 
• Not an existing GIDEON customer? Don’t worry. We’ve got you covered. Sign up for a free demo to get started.

Conclusion

GIDEON is one of the most well-known and comprehensive global public health databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. 

The GIDEON R package allows researchers to retrieve, clean, analyze, and visualize infectious disease data in real-time from the GIDEON database without the need to get familiar with API clients and learn to program their own API queries. This improves the efficiency and reproducibility of research methods and results and lowers the time and costs required to learn how to work with REST APIs.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Mycetoma, Relapsing fever, Sarcocystosis, and more. Or check out our global status updates on countries like Sao Tome and Principe, Cayman Islands, Falkland Islands, and more!

References

The post Less Prep, More Insights: GIDEON R for Epidemiology Research appeared first on GIDEON.

Meanwhile, in real life, a large and vocal group of researchers and public health organizations are sounding the alarm about Dengue as a pandemic-level threat in the near future.

The relatively good news is that Dengue, a vector-borne illness, is not transmissible between humans. So, we can prevent a full-blown Dengue pandemic if the global community of public health officials:

• Train frontline health professionals on early and accurate detection and treatment,
• Implement protective and preventive measures to mitigate Dengue risk, and
• Consistently track Dengue cases and outbreaks using robust databases like WHO and GIDEON

But why is Dengue such a colossal threat? Why is prevention important?

Dengue Cases On The Rise

Dengue cases are estimated to be anywhere from 5 – 100 million. This wide range is because many cases stay unreported, or the symptoms of Dengue are confused for other diseases. But the number of Dengue cases is expected to boom in the next few decades, with 60% growth by 2080 [1].

Tracking the geographical spread of the Dengue virus by different vectors is complex.

Reported Dengue cases in different regions, 1980 – 2020

Image: Graph illustrating Dengue cases in different regions, 1980 – 2020. Copyright © GIDEON Informatics, Inc.

Dengue Mosquito Spreads Its Wings Worldwide

While Dengue cases are primarily found in the tropical regions of Asia, Africa, and the Americas, this is rapidly changing. The study from Spain determined that other regions now at risk are South-East China, Papua New Guinea, North Australia, South USA, parts of Colombia, Venezuela, Madagascar, and even Japan and South and Central Europe. The study predicts that Dengue could spread from Pakistan and the Arabian Peninsula to Argentina and South-West Asia.

Ideally, public health officials in these regions will begin training their healthcare professionals to diagnose and treat Dengue early and raise awareness among their populations.

For example, Egypt’s Ministry of Health initially dismissed reports of Dengue fever in certain regions. But eventually, they reviewed published reports of Dengue outbreaks in studies that used GIDEON’s clinical tools. This prompted them to develop a training program for their health workers for the early detection and treatment of Dengue [5].

Two significant factors accelerating dengue virus transmission worldwide are the 2.9 trillion U.S dollar global travel and tourism industry and climate change.

Many studies indicate that international travelers are at considerable risk for Dengue spread. Ratnam et al. from Australia concluded that Dengue infections in international travelers occur frequently and may be associated with substantial morbidity [6].

It is worrisome that while Dengue is not directly contagious among humans, it is transmittable from an infected human to an infection-free aedes aegypti mosquito. So, if a Dengue-infected individual travels to another country during the viremic or infection-spreading period, a native Aedes mosquito may bite the individual and become infected [7]. This newly infected mosquito can infect other individuals.

Additionally, climate change contributes because rising temperatures in previously colder environments are fertile grounds for mosquitoes to thrive. Higher temperatures also shorten the cycle of a mosquito picking up a dengue virus infection and transmitting it.

Captured in La Paz, Honduras, this August 2019 photograph, depicted Dr. Liliana Sanchez-Gonzales on the left, an Epidemiologist with the Centers for Disease Control and Prevention’s (CDC) Dengue Branch, along with an unidentified Honduran physician, as they were examining the chest x-ray of a patient, who was on the verge of developing severe dengue. The x-ray revealed the presence of fluid in her lungs, possibly due to plasma leakage, as she was going into dengue-related shock.

Why is the Virus Dangerous?

According to WHO, severe Dengue is a leading cause of serious illness, hospitalization, and death among children and adults in some Asian and Latin American countries [4]. Severe Dengue involves severe bleeding, liver, heart, other organ impairment, and plasma leakage.

Many Dengue infections are mild with flu-like symptoms, but a lack of awareness and early detection could lead to severe Dengue. And since the incubation period varies from four to ten days, it may be overlooked or misdiagnosed until it becomes severe. Additionally, because there are four different types of the Dengue virus, individuals once affected by Dengue can be re-infected up to four times.

The Dengue vaccine is only available in certain countries and, as per WHO, is restricted to those aged 9 to 45 and individuals previously infected by DENV. Hopefully, we get a better alternative. But until then, we need to raise awareness about early detection and treatment on the frontlines and track outbreaks closely.

Diagnosing Dengue Fever and Addressing Symptoms

Dengue fever is a viral infection that is transmitted by mosquitoes. Dengue fever symptoms can range from mild to severe, and they typically include fever, headache, nausea, vomiting, muscle and joint pain, and rash. Dengue fever can sometimes lead to more severe complications, such as hemorrhagic fever and dengue shock syndrome.

Early diagnosis of dengue fever is essential to provide the best possible treatment and outcome for the patient. Several methods can diagnose dengue fever, including clinical examination, laboratory testing, and imaging studies. A detailed history and physical examination can often provide clues to diagnosing dengue fever, but laboratory confirmation is usually necessary.

Laboratory tests, including complete blood count, serum electrolytes, liver function tests, and serology, may be ordered. Imaging studies are generally not needed for the diagnosis of dengue fever, but they may help assess for complications. Treatment of dengue fever focuses on relieving symptoms and supporting the patient through the acute phase of the illness. There is no specific antiviral therapy for dengue fever, so treatment is supportive.

Preventing the Spread of Dengue Fever

Dengue fever is a disease caused by a virus that is spread by mosquitoes. It is a leading cause of illness and death in many tropical and subtropical countries. The best way to prevent it is to avoid mosquito bites. Mosquitoes that spread dengue fever bite during the day, so it is important to use insect repellent, wear long-sleeved shirts and pants, and stay in air-conditioned or well-screened rooms. You can also reduce the risk of mosquito bites by emptying containers of standing water, where mosquitoes lay their eggs.

Taking these steps can help to prevent the spread of dengue fever. We can also help prevent the spread by becoming more informed and making data accessible to care providers; that is where GIDEON comes into play.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous data stream. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Rheumatic Fever and Scarlet Fever, Schistosoma Haematobium, Taenia and Diphyllobothrium, and more. Or check out our global status updates on countries like Senegal, Comoros and Mayotte, Maldives, and more!

References

The post Dengue Fever and What You Need to Know appeared first on GIDEON.

Image: World map of Monkeypox outbreaks, 2018-2021. Copyright © GIDEON Informatics, Inc.

Hot on the heels of the COVID-19 virus and its variants, another infectious virus recently landed in the United States. On July 9th, 2021, a passenger with monkeypox flew from Lagos in Nigeria to the United States, ultimately landing in Dallas, Texas. The Centers for Disease Control and Prevention, CDC confirmed the case of Monkeypox on July 15th – the first case of monkeypox in the United States in almost 20 years. While rare, the Monkeypox virus is contagious and kills one in ten people that it infects.

“…we are only a plane ride away from any global infectious disease.”

– Dr. Philip Huang, Director of the Dallas County Health and Human Services.

A few fortunate events prevented a Monkeypox outbreak in the United States this time around. 

1. Symptoms Presented Early: Symptoms of monkeypox are similar to those of smallpox and can take anywhere from 7 to 14 days to appear after getting infected (incubation period). Luckily, symptoms presented earlier, and the patient visited a hospital within four days of entry into the country. 
2. Early Detection by Frontline Clinicians: The symptoms of monkeypox include fever, headache, backache, swollen lymph nodes, chills, and fatigue. Within three days of the onset of fever, a rash appears on the face and spreads to other parts of the body. Doctors and healthcare workers at the Dallas hospital were able to identify and diagnose monkeypox quickly, so the infected patient was isolated early. 
3. Mask Mandates and Social Distancing: Monkeypox can spread from person to person through respiratory droplets and body fluids. In this instance, a huge silver lining is that due to COVID-19 mandates, everyone, including the patient, other passengers, airline and airport staff, and others wore masks. This helped prevent the spread. 

Monkeypox is transmitted to humans through infected animals or other humans. Animals can share it through bites, scratches, or direct contact with body fluids. Human transmission is mostly through respiratory droplets and body fluids but also contact with contaminated clothes. 

While there was no outbreak this time, there have been a few in prior years.

Monkeypox Infection Outbreaks

In the case of monkeypox, there have been notable outbreaks in the past. In 2003, 81 people in the United States were infected with monkeypox through contact with prairie dogs. These animals acquired the virus from rodents imported from Ghana.

Image: Prairie dog family watching around their hole

In 2018-2019, five cases of monkeypox were reported in Israel, Singapore, and London. The UK also had one additional case in May 2021. Worldwide, Monkeypox cases are on the rise. In 2020, almost 4,500 cases of monkeypox were reported in the Democratic Republic of Congo in just nine months. 

According to the GIDEON country note on Monkeypox in Nigeria, there were six cross-border events of monkeypox from Nigeria to other countries and two notable monkeypox outbreaks. In the latest one from 2017-2021, 446 people in Nigeria were ill with Monkeypox.

Image: Graph illustrating Monkeypox cases in Nigeria 1970 – 2019. Copyright © GIDEON Informatics, Inc.

Diagnosing Monkeypox Accurately

Monkeypox has specific symptoms that distinguish it from other diseases. Swollen lymph nodes and a telltale rash help diagnose it more accurately, but misdiagnosis is possible. 

Let’s look at the illustration below. When we add patient travel history from Nigeria and the symptoms of monkeypox like fever, headache, generalized lymphadenopathy, skin lesions or rash, and others into the GIDEON infectious disease diagnostic probability engine, Varicella is also a strong contender. But the presence of ‘severe illness’ and the type of rash signifies a greater probability of Monkeypox.

Image: GIDEON probability engine, differential diagnosis of Monkeypox. Copyright © GIDEON Informatics, Inc.

GIDEON’S side-by-side comparison of the clinical features of Monkeypox and Varicella virus helps narrow down and confirm the Monkeypox diagnosis based on patient presentation. 

Image: GIDEON disease comparison table – Monkeypox vs. Varicella. Copyright © GIDEON Informatics, Inc.

As Monkeypox has no cure, saving lives relies on early detection and control of spread.  Although there is some evidence that vaccination against smallpox may also prevent monkeypox, the Smallpox vaccine is no longer used. Another outbreak could happen anywhere, anytime.

Are we prepared to detect the next infectious disease that crosses our shores early? 

Detecting Foreign Infectious Diseases Early

Regarding the July 2021 Monkeypox case in Dallas, Dr. Philip Huang, the Director of the Dallas County Health and Human Services, stated, “This is another demonstration of the importance of maintaining a strong public health infrastructure, as we are only a plane ride away from any global infectious disease.”

Indeed, as the COVID-19 pandemic demonstrated, it is easy for emerging infectious diseases to spread rapidly worldwide. As seen in the Texas Monkeypox case, if patient travel history is considered at first presentation and symptoms are detected early, we can stop the spread of a disease-causing pathogen. 

Healthcare providers are our first line of defense against infectious diseases. Unfortunately, clinicians, nurses, emergency room workers, paramedics, and ambulance drivers in clinics and hospitals are also some of the first casualties from infection. The World Health Organization (WHO) recently reported that 115,000 healthcare workers have died from COVID-19. With the Delta variant on the loose, the pandemic is very much underway, and this number may rise. Protecting our borders and healthcare workers from emerging infectious diseases requires better access to advanced diagnostic tools with epidemiological data. 

When frontline clinicians have doubts about their initial assessment, they can conduct a differential diagnosis by comparing a patient’s symptoms with other diseases or consult infectious disease specialists. However, if they do not, or cannot, refer to a specialist or use an infectious disease platform for differential diagnosis (DDx), the disease-causing virus or bacteria may be misidentified and spread unchecked. 

The best way to catch emerging infectious diseases early is to equip frontline clinicians with comprehensive data on all reported infectious diseases, including:

• a list of symptoms, 
• the ability to compare conditions with similar presentations, and 
• a history of global outbreaks and documented cases, 
• country-specific notes on disease outbreaks. 

The GIDEON Difference in Public Health

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases for communicable diseases surveillance. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Rhinoscleroma and Ozena, Schistosoma Japonicum, Trachoma, and more. Or check out our global status updates on countries like Sierra Leone, Czech Republic, Northern Marianas, and more!

The post Monkeypox Outbreaks in Texas: Are We Ready to Prevent the Next Outbreak? appeared first on GIDEON.

Pathogen of the Month

Doubt strikes fear into the hearts of many. But it is a powerful tool in the hands of medical professionals and researchers. Being uncertain is the impetus that drives truth-seeking peer-to-peer verification and differential diagnoses that can help save lives.

Take Legionnaires’ disease. It is one of the leading causes of pneumonia worldwide [1]. If left untreated without the right antibiotics, it can be fatal. In the United States alone, the economic burden of just one year of Legionnaires’ disease cases can be over 800 million US dollars [2]. This is part of why disease prevention is so critical even in developed countries.

Surprisingly, it is often overlooked. So much so that even the World Health Organization or WHO states, “Since many countries lack appropriate methods of diagnosing the infection or sufficient surveillance systems, the rate of occurrence is unknown. In Europe, Australia, and the USA, there are about 10–15 cases detected per million population per year [1].”

A great place to begin addressing these challenges is if clinicians are willing to embrace doubt when faced with diagnosing pneumonia-like symptoms.

What Causes Legionnaires’ Disease or Legionellosis?

There were many historical events in 1976. NASA unveiled their first space shuttle, Apple Computers was born, and the first Rocky movie was released. Unfortunately, it was also the year a tragic event led to the discovery of Legionnaires’ disease.

On July 21st, 1976, 4000 delegates from the American Legion, America’s largest veterans’ service organization, traveled to Philadelphia for a convention. Within a few weeks, almost 200 got sick with an upper respiratory illness, and 29 died. It took nearly five months of investigations to identify the pathogen – Legionella – as the cause [3].

Legionnaires’ disease or Legionellosis is caused by the bacteria Legionella. It lives in water and soil and can cause health issues when it grows in showerheads and faucets, hot tubs, and in stagnant water and air conditioning systems in large buildings. We are susceptible to infection by Legionella when we inhale water droplets with the bacteria in it or come in contact with contaminated soil, whether we are otherwise healthy or not. Legionellosis, or Pontiac Fever, is not spread through direct human-to-human transmission. It has an incubation period of 2 to 10 days. This can make prevention tricky.

Legionella is widely found in warm water environments, so most cases of Legionnaires occur in the summer and early autumn. Legionnaires’ is a public health issue. Cassell et al. caution that utmost care must be taken when COVID-19 restrictions are lifted worldwide. Going back to work or school in buildings left unoccupied or unused during lockdowns is a risk factor for Pontiac fever [4]. 

Paterna, Valencia, Spain, 2020; The Legionella training

Why is Legionnaires’ Disease Often Misdiagnosed or Overlooked?

According to Reller et al. [5], a wrong Pontiac fever diagnosis is often due to:

•  The inability to distinguish Legionnaires’ disease from other types of pneumonia, clinically and radiographically,
•  Failure to order diagnostic tests for Legionella infection, and
•  Inadequacies in current diagnostic tests and protocols.

The majority of Legionnaires’ disease cases each year remain undiagnosed; the world still awaits better diagnostic tests and protocols for Pontiac Fever. But the issue of “failure to order diagnostic tests for Legionella infections” can be fixed. The Urine Antigen Test (UAT) and sputum tests prescribed for Legionella are inexpensive, so cost is not the issue.

The solution lies in training medical professionals to embrace doubt and challenge their confirmation biases. Clinicians who take a few minutes to input a patient’s pneumonia and accompanying symptoms on a robust, clinical decision support tool like GIDEON  can better understand how to proceed. 

For example, when the COVID-19 pandemic hit, experts cautioned clinicians to be on the alert for Pontiac Fever as well. The concern was that clinicians might repeatedly be testing community-acquired pneumonia patients for COVID-19 but not Legionellosis – which would delay diagnosis and treatment. Since initial clinical presentations for the two are similar, clinical decision tools can be extremely useful.

GIDEON, for example, has a built-in feature to help clinicians challenge their confirmation biases. A ‘Why Not?’ feature helps clinicians understand why a specific diagnosis does not show up on the list of probable causes of a patient’s symptoms.

Legionnaires’ disease, misdiagnosed as Malaria, can be fatal because malarial drugs do not work against Legionella. It is even more critical to get the right diagnosis early. 

Legionellosis or Pontiac Fever Misdiagnosed as Malaria

Take the example of the agricultural expert from Israel wrongly diagnosed with malaria instead of Legionellosis. He had traveled to India to work on a farming project in 2005. A week later, when he returned to Israel, he developed fever, headache, vomiting, and muscle pain. In two days, he felt better, but the symptoms reappeared with cough, shortness of breath, and rigors in tow. The patient was highly lethargic, hypotensive, and blood tests showed elevated bilirubin and creatinine levels.

Because of his recent travel to India, doctors thought it was Malaria. He was started on malarial medication while laboratory tests were being processed. But when blood smears proved negative for Malaria, his doctors wondered if it was Dengue.

Luckily for him, his doctors decided to challenge their cognitive biases and conducted a differential diagnosis. They entered the patient’s symptoms in the popular DDx or differential diagnosis tool, GIDEON. To their surprise, neither Malaria nor Dengue showed up as possibilities. But given the symptoms and the incubation period, Legionellosis turned out to be the prime (and accurate) suspect. This saved his life because standard malarial therapy does not work against Legionella.

Putting it All Together

Misdiagnosing Legionnaires’ disease can be fatal, lead to a public health crisis, and add hundreds of millions to an already astronomically high healthcare burden. The safety of our communities relies on the prevention of these illnesses and we need to stop overlooking them.

One of the main reasons it is often overlooked is that clinicians may not think about testing for Legionellosis when treating a patient with pneumonia, especially when they are otherwise healthy. This can put the safety of the patient at risk.

Equipping clinicians with the right clinical diagnosis tools can help them validate their assumptions. Not only that, using a tool like GIDEON, clinicians can also challenge their confirmation biases and learn why a diagnosis does not apply to a specific set of symptoms.

Getting to the correct answer starts with harboring and encouraging healthy doubt in initial diagnoses. As the famous philosopher, Voltaire said, “Doubt is not a pleasant condition, but certainty is absurd.”

The GIDEON Difference in Disease Prevention

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases that can help with disease control and prevention. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Schistosoma Mansoni, Trichinosis, Sindbis Group Viruses, and more. Or check out our global status updates on countries like Slovakia, the Seychelles, the Turks and Caicos Islands, and more!

References

The post Misdiagnosing Legionellosis and Legionnaires Disease Can Be Fatal. But Why Is It Still Common? appeared first on GIDEON.

Louis Pasteur, the inventor of four vaccines, in his laboratory, 1885

The COVID-19 pandemic has been an eye-opener regarding the detrimental impact of microbial species on the human body. Vaccines are vital for developing immunity against various infectious organisms by recognizing the immune system’s targeted pathogens. 

The initial development of vaccines resulted from the tireless efforts of many prestigious researchers who selflessly pursued the prevention of infectious diseases. Here is a brief sneak peek into the contributions of a few of these scientists whose invaluable efforts have saved millions of lives.

Louis Pasteur

In the 1880s, Louis Pasteur developed vaccines for four potentially fatal infections, including Chicken Cholera, Anthrax, Swine Erysipelas, and Rabies. He was the first to introduce the use of live attenuated pathogens to develop immunity against causative organisms (1). The vaccine for Chicken Cholera (Pasteurella multocida) was the first to be developed in a laboratory. Pasteur received several medals and honors, including the Leeuwenhoek Medal from the Royal Netherlands Academy of Arts and Sciences for his contributions to microbiology in 1895 (2).

Rabies cases and rates worldwide, 1990 – 2015

Waldemar Mordecai Wolffe Haffkine

Waldemar Haffkine developed the first vaccines for Cholera and Plague, in the 1890s (3). Haffkine tested these inoculations on himself before initiating mass human trials. He conducted most of his studies in India, a hub of Cholera and Plague, and his monumental work saved the lives of millions of people.

Plague cases and rates 1948 – 2018

Jesse William Lazear

Dr. Jesse Lazear was an American physician who played a critical role in understanding the transmission of Yellow fever, a life-threatening viral infection (4). It was later revealed that he “allowed himself to be bitten by mosquitoes that had fed on the blood of patients with yellow fever,” which eventually led to his demise. His sacrifice was crucial in establishing the relationship between mosquitoes and Yellow fever, which later formed the basis of the development of key preventative strategies.

Max Theiler

Max Theiler received the Nobel Prize in Medicine or Physiology “for his discoveries concerning Yellow fever and how to combat it” in 1951 (5). He pioneered the work of developing a safe, standardized vaccine for the disease. In his studies, he used mice instead of rhesus monkeys, which were considered to be the main reservoir of the infection. Following this, mice continued to serve as standard tools for the study of zoonotic diseases by future researchers (6).

Yellow fever cases and rates worldwide, 1950 – 2016

Pearl Kendrick (left) and Grace Eldering. Photo credit: Michigan Women’s Hall of Fame

Grace Eldering & Pearl Kendrick

Both scientists conducted in-depth studies on Pertussis (whooping cough), which then became the basis of the development of a vaccine (7). Interestingly, both Grace Eldering and Pearl Kendrick suffered from whooping cough in their childhood, which was said to be the motivation behind their work. They were also involved in combining the Pertussis vaccine with those of Diphtheria and Tetanus to produce the DPT vaccine.

Pertussis cases and rates worldwide, 1980 – 2018

John Franklin Enders

John Franklin Enders is referred to as “The Father of Modern Vaccines.” In 1954, he, along with Thomas H. Weller and Frederick C. Robbins, received the Nobel Prize in Physiology or Medicine for the successful in-vitro culture of the Poliomyelitis viruses (poliovirus) (8). Subsequently, Enders and his colleagues worked on developing a vaccine against the Measles virus, resulting in the availability of a live attenuated Measles virus vaccine and a deactivated Measles virus vaccine – marketed by Merck & Co. and Pfizer, respectively (9).

Measles cases and rates worldwide, 1980 – 2019

The names mentioned above are just a few of the many scientists whose dedication, hard work, and intellect helped develop safe and effective vaccines, providing immeasurable contributions to our healthcare system.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Streptococcus suis, Trichomoniasis, Strongyloidiasis, and more. Or check out our global status updates on countries like South Sudan, Sri Lanka, the United Arab Emirates, and more!

References

1. FLEMING A. Louis Pasteur. Br Med J. 1947 Apr 19;1(4502):517-22. doi: 10.1136/bmj.1.4502.517.
2. “Leeuwenhoek Medal”, Royal Netherlands Academy of Arts and Sciences [Online]
3.     Hawgood BJ. Waldemar Mordecai Haffkine, CIE (1860-1930): prophylactic vaccination against Cholera and bubonic Plague in British India. J Med Biogr. 2007 Feb;15(1):9-19. doi: 10.1258/j.jmb.2007.05-59.
4.     Reed W, Carroll J, Agramonte A, Lazear JW. Classics in infectious diseases. The etiology of yellow fever: a preliminary note. Walter Reed, James Carroll, A. Agramonte, and Jesse W. Lazear, Surgeons, U.S. Army. The Philadelphia Medical Journal 1900. Rev Infect Dis. 1983 Nov-Dec;5(6):1103-11.
5.     “Max Theiler Biographical”, The Nobel Prize [Online]
6.     Norrby E. Yellow fever and Max Theiler: the only Nobel Prize for a virus vaccine. J Exp Med. 2007 Nov 26;204(12):2779-84. doi: 10.1084/jem.20072290.
7.     Shapiro-Shapin CG. Pearl Kendrick, Grace Eldering, and the pertussis vaccine. Emerg Infect Dis. 2010 Aug;16(8):1273-8. doi: 10.3201/eid1608.100288.
8.     “John F. Enders Biographical”, The Nobel Prize [Online]
9.     Katz SL. John F. Enders and measles virus vaccine–a reminiscence. Curr Top Microbiol Immunol. 2009; 329:3-11. doi: 10.1007/978-3-540-70523-9_1.

The post Vaccine History and Heroes appeared first on GIDEON.

“The rapid spread of Dengue could lead to a global pandemic, and so the geographical extent of this spread needs to be assessed and predicted. There are also reasons to suggest that transmission of Dengue from non-human primates in tropical forest cycles is being underestimated.”

Alisa Aliaga-Samanez

Exactly one month ago, on June 7th, PLOS Neglected Tropical Diseases published a research article Worldwide dynamic biogeography of zoonotic and anthroponotic Dengue. The study is the first high-resolution analysis of how the risk of Dengue transmission has been changing geographically since the late 20th century, indicating the virus (DENV) has been making a home in previously low-risk areas, potentially due to global warming and deforestation. 

We spoke with the corresponding author Alisa Aliaga-Samanez, who worked alongside Marina Cobos-Mayo, Raimundo Real, Marina Segura, David Romero, Julia E. Fa, and Jesús Olivero, to learn more about the importance of this study and her experience working with GIDEON data. 

How did you find out about GIDEON?  

We got to know GIDEON thanks to an article published in PNAS by Kris A. Murray and colleagues entitled “Global biogeography of human infectious diseases.”

What were the reasons behind choosing the GIDEON database as one of your data sources?

We know that GIDEON is one of the most complete data sources worldwide on zoonoses, so we wanted to use it to build our database. For that reason, the project where I work at the University of Malaga funded our access to GIDEON.

What is the importance of biogeography studies like this one to public health management?  

Biogeographical studies, through modeling, applied to pathogens, allow us to understand the distribution of infectious diseases. The occurrence of disease cases is related to social factors but also to environmental variables that determine the degree to which certain environments favor the occurrence of disease, even where it has not been recorded. Thanks to the tool we use in our study, we are able to propose different management strategies depending on which factors favor the risk of transmission in different regions of the world. We took into account three possible biogeographical scenarios related to Dengue transmission risk: (1) zones with favorable conditions for viruses and vectors, (2) favorable conditions for virus only, and (3) favorable conditions for vectors only. Besides, our biogeographical approach helped us to analyze the extent of the areas where non-human primates could be involved in sylvatic Dengue cycles.

Do you believe the risks of the Dengue pandemic are exacerbated by global warming?  

We think global warming may be one of the factors that could be favoring vectors to adapt to new environments. A study published by Messina and colleagues in 2019 concluded that the World’s population at risk of Dengue could experience an almost 60% increase by 2080. In addition, they suggested that outbreaks could reach areas in continents such as Australia, Argentina, Japan, eastern China, and southern Europe.

Photo by William Bossen on Unsplash

In your experience, how effective study such as yours at influencing change in government and health policies, and do you think work like this will be taken more seriously following the COVID-19 pandemic?  

We have seen that governmental bodies such as WHO or CDC rely on scientific studies to manage risk areas, but we feel that this work is being limited in Africa, for example. On the other hand, some diseases already have a vaccine available, such as yellow fever, but its application might not be well managed in some African countries, where large outbreaks occur. In the case of Dengue, a vaccine has already been developed, but it is only licensed for people aged 9-45 years in some countries. The WHO recommends that the vaccine should only be administered to people with confirmed previous Dengue virus infection. As we show in our paper, Dengue is currently spreading together with its vectors. The COVID-19 pandemic should serve to demonstrate that global pandemics are possible and, so, must be prevented.

What value did having access to global spatio-temporal data add to your study?  

GIDEON helped us to get quick access to the available information on the disease. This allowed us to build our databases in a short time and to validate our models with recent cases in order to assess the reliability of the tool we use and to predict new areas favorable for new Dengue cases.

What are your thoughts regarding data availability on sylvatic transmitted Dengue?  

Most of the available data on human cases do not differentiate whether they were caused by sylvatic or urban transmission. Some research studies in certain local areas may be able to determine this, but globally there is no such information. Our biogeographic outputs related to Africa and Asia are consistent with the scarce information available and provide the context in which on-the-ground prospections on sylvatic Dengue should be addressed. This is especially important in South America, where sylvatic Dengue has not been detected yet (although the presence of sylvatic Yellow Fever and other evidence are starting to suggest its existence).

Aedes aegypti mosquito, the vector of Dengue

What areas do you think GIDEON could improve to make our data more useful to you in the future?  

We appreciate the great work GIDEON does in collecting data globally. We found the new GIDEON interface very useful. Perhaps it would make it easier in the future, if it is possible, to distinguish between imported and autochthonous cases within the database. It is true that in many cases the database does mention it but not for all countries.

About Alisa:

Alisa Aliaga-Samanez has a degree in Biology from the Federico Villarreal University (Peru) and a Master’s degree in Biodiversity and Environment from the University of Malaga (Spain). Currently, she is working at the Animal Biology Department of the University of Malaga, being part of the Biogeography, Diversity and Conservation Group,  developing her Ph.D. thesis. The thesis is focused on the study of primate biogeography, applied to conservation and human health. She is currently mapping vector-borne zoonotic diseases through global distribution modeling. This is why she is able to track dengue and dengue virus serotype.

Aliaga uses high-resolution global maps and the most up-to-date databases to analyze geographical changes in the risk of zoonotic disease transmission. In addition, in these analyses, she considers the biogeographical contribution of primates in increasing the risk of transmission. She seeks to determine the potential natural range of endemic and emerging zoonotic diseases in the world, with the aim of suggesting specific management strategies according to the spatial distribution of risk factors.

Click here to read the open-access article: Worldwide dynamic biogeography of zoonotic and anthroponotic Dengue 

The GIDEON Difference in Tracking Virus Transmission

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Suppurative Intracranial Infections, Trichuriasis, Tropical Skin Ulcers, and more. Or check out our global status updates on countries like Suriname, Togo,  Ukraine, and more!

The post Tracking Dengue: An Interview With Alisa Aliaga-Samanez appeared first on GIDEON.

Pulmonary Tuberculosis ( TB ): Chest x-ray shows alveolar infiltration at both lungs due to Mycobacterium tuberculosis infection

Global Burden of the Disease

The World Health Organization (WHO) has reported a 22% decrease in TB-related mortality between 2000-2015, with a gradual 1.5% decrease in the annual rate. However, despite this trend and successful control of disease transmission, TB continues to have a significantly higher rate of morbidity. In 2015, six countries (China, India, Nigeria, Pakistan, Indonesia, and South Africa) accounted for 60% of TB-related deaths [3].

Global cases of Tuberculosis between 1965-2019

Pathogenicity of Mycobacterium Tuberculosis

Mycobacterium tuberculosis is transmitted in the form of droplet nuclei exhaled by individuals affected with laryngeal/pulmonary TB. It enters the body via the nasal cavity/mouth and travels to the alveoli of the lungs, where it recruits macrophages, in turn transporting the bacteria to the deeper tissues [4]. Another round of macrophage recruitment to the originally infected locus forms an organized aggregate of differentiated macrophages and immune cells called a granuloma. The infected granuloma undergoes necrosis, promoting bacterial growth and transmission to the next host [5].

Diagnosis of TB Infection

Some patients with TB may present with non-specific findings such as anemia, weight loss, fever of unknown origin, and fatigue; while others may be asymptomatic and show no abnormalities on physical examination [6]. Thus, the physician should collect body fluids/tissues for Acid-Fast bacilli (AFB) smear and culture.  Only a positive culture can confirm the diagnosis of TB. This is why TB tests are common practice in health care settings as is the prevention and disease control of tuberculosis. Testing for TB is critical to the prevention of the spread of the bacteria because knowing if you have an infection can be the first step in making sure that you are not spreading that same infection to those around you.

Confirmatory and diagnostic testing for TB:

• Culture, followed by Ziehl-Neelsen (AFB) staining
• A Chest X-ray to confirm the diagnosis in case of positive culture, indicating active disease
• Gene-based testing and nuclear amplification to identify the bacterial strains using DNA-based molecular techniques, such as GeneXpert [7].

Ziehl-Neelsen staining

AFB staining is the traditional method of TB diagnosis, as it is inexpensive and provides rapid results [8]. Mycobacterium species retain dyes when heated and treated with acidified organic compounds. The most common acid-fast staining method for M. tuberculosis is the Ziehl-Neelsen stain method, in which a bacteria specimen is fixed, stained with carbol-fuchsin dye, and decolorized with an acid-alcohol mixture. After counter-staining the smear with methylene blue or a similar dye, AFB appears red against a contrasting blue background [9].  In general, a sputum sample must contain at least 10,000 organisms/mL to visualize these bacteria at 100x magnification. 

Latent TB vs. Active TB

Latent TB represents the condition where the body’s immune system restricts the growth of M. tuberculosis bacterium, making the individual appear asymptomatic [10]. This can make tracking the prevention of spreading TB and disease control success difficult. Research has shown that its important for latent cases to be considered.

An individual with latent TB infection shows

• no symptoms.
• is not infectious (cannot spread TB).
• tests positive for TB blood/skin tests.
• may eventually develop active TB if the immune system weakens.

Active TB represents a condition where the body’s immune system is unable to restrict the growth of M. tuberculosis, rendering patients both ill and contagious. This is what most people think of when they think of a TB infection.

The symptoms of TB depend on the affected area.

a. General symptoms include:

• Night sweats
• Weight loss
• Prolonged fever
• Loss of appetite
• Fatigue

b. Symptoms of Pulmonary TB (infected lungs):

• Shortness of breath, which progressively worsens
• A persistent cough that produces phlegm and sometimes blood, persisting  > 3 weeks. 

c. Symptoms in the case when other areas of the body are infected:

• Swellings in the neck or other regions
• Pain in a joint or affected bone
• Abdominal pain
• Headache
• Confusion
• Seizures

Treatment

According to the World Health Organization (WHO), first-line treatment for TB may include combinations of five essential drugs: Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S) [11].  Patients with TB undergo a standardized treatment for 6 to 9 months, including an initial two-month course of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol, followed by another 4-month course of Isoniazid and Rifampicin [12].

For patients with Multi Drug-Resistant Tuberculosis (MDR-TB), directly-observed therapy (DOT) is used. In DOT, drugs are administered at least six days/week under the direct observation of the physician [13, 14]

BCG vaccine

Bacillus Calmette-Guerin (BCG), a vaccine for TB, was introduced in 1921 to control tuberculosis in humans. It is administered at birth, primarily in regions with a high disease burden, such as India, South Africa, and Pakistan [15]. Widespread immunization using the BCG vaccine has facilitated a reduction in TB cases globally [16].

Risk Factors

Five-to-ten percent of people with latent TB who do not receive appropriate treatment will eventually develop active TB infection [17]

Individuals at a higher risk of contracting TB and developing an infection include:

• Those who have traveled to or are living in a country with a high prevalence of TB. 
• Those living in crowded conditions
• Those who have been in close contact with a person infected with TB
• Children ages <= 5 years who have tested positive for a TB infection
• People who reside or work with persons at high risk for TB infection, such as those in hospitals, correctional facilities, homeless shelters, residential homes for HIV-infected individuals, and nursing homes

Additionally, immune dysfunction associated with diabetes mellitus, HIV infection, cancer chemotherapy, malnutrition, and advanced age is associated with an increased risk of contracting TB. 

Additional conditions associated with high risk for tuberculosis include silicosis, substance abuse, malignancy, organ transplantation, corticosteroid therapy, Crohn’s disease, and rheumatoid arthritis.

Tuberculosis and HIV

Co-infection by TB and HIV places a diagnostic and therapeutic burden on the health care system. HIV infection has been shown to increase the risk of reactivation of latent TB by 20-fold. [18].

The GIDEON Difference in Public Health

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. Check out some of our other content like Web-Based Analytics for Investigation of Disease Outbreaks, Cellphones Are ‘Trojan Horses’ for Viruses, Study Finds, Globalization and Health, and If You Gotta Go, Are Public Restrooms Safe On A Road Trip?

References

1.     K. R, Die Aetiologie der Tuberculose [The aetiology of Tuberculosis.], Berlin: Berliner Klinische Wochenschrift, 1882.
2. F. K. Dye C, Disease Control Priorities in Developing Countries, New York:: Oxford University Press, 2006.
3. Z. J. B. Q. H. H. B. L. Y. J. L. Q. L. J. Pan Z, “The Gap Between Global Tuberculosis Incidence and the First Milestone of the WHO End Tuberculosis Strategy: An Analysis Based on the Global Burden of Disease 2017 Database.,” 2020.
4. CDC, How TB Spreads, CDC, 2016.
5. G. M. J. Jr., “Microbial pathogenesis of Mycobacterium Tuberculosis: dawn of a discipline,” Cell, no. 104, pp. 477-485, 2001.
6. J. D. E, Mycobacterial diseases of the lung and bronchial tree: Clinical and laboratory aspects of Tuberculosis, Boston: Brown and Company, 1974.
7. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK441916/.
8. B. J. R. Elizabeth A. Talbot, Molecular Medical Microbiology, 2015.
9. R. l. Kradin, Diagnostic Pathology of Infectious Disease, 2018.
10. World Health Organization, Guidelines on the management of latent Tuberculosis infection, Geneva: WHO, 2015.
11. World Health Organization, Implementing the WHO Stop TB Strategy: A Handbook for National Tuberculosis Control Programmes.
12. Gideononline, “www.gideonoline.com,” Gideon, 2021. [Online]
13. A. F. Z. L. F. E. Terracciano E, [Tuberculosis: an ever-present disease but difficult to prevent], Ig Sanita, 2020.
14. M.-R. K. R. R. C. R. Chaulk CP, Eleven years of community-based directly observed therapy for Tuberculosis, JAMA, 1995.
15. “www.journals.plos.org,” [Online]
16. Z. a. Lancione, “Using data science to improve knowledge around a century-old vaccine,” The BCG Atlas, 2020.
17. CDC. [Online]
18. G. C. G. R. N. P. Getahun H, “HIV infection-associated tuberculosis: the epidemiology and the response,” Pubmed, 2010.

The post What is Mycobacterium Tuberculosis? appeared first on GIDEON.

“Our results indicate that factors fostering a disease outbreak in one country can quickly lead to the emergence of a disease outbreak in another country.”

In March 2021, the Journal of Mathematical Economics published a research paper, Spatial dynamics of major infectious diseases outbreaks: A global empirical assessment. The article explored the spatial dependence of outbreaks and the role of globalization, analyzing 20 years’ worth of major outbreaks in developed and developing countries. The study found empirical evidence that ‘local outbreaks of many different infectious diseases can quickly spread to other countries’. Mortality consequences were found to be ‘much more severe in developing countries’.

Prof. Rodolphe Desbordes

We spoke with the author Rodolphe Desbordes, a Professor of Economics at SKEMA Business School, about the importance of this research and the reasons behind choosing GIDEON as the data source.

Prof. Desbordes has widely published in the fields of International Economics and Economic Development. His current research interests encompass applied econometrics, determinants of political regime changes, and the links between biodiversity, economic activity, and zoonotic diseases.

How did you find out about GIDEON? 

I was looking for data with worldwide coverage on outbreaks of infectious diseases. I was really surprised not to find this information easily (e.g. provided by the WHO). In a few papers, I noticed their use of GIDEON.

What were the reasons behind choosing the GIDEON database for your analysis? 

I am really an applied macroeconomist, often interested in very global issues. For this reason, I need databases with long (time) and wide (spatial) coverage to run estimations. GIDEON was the perfect database for the epidemiological project I had in mind. In addition, for a non-specialist, the information provided on each disease was crucial to a better understanding of disease-specific characteristics.

How could healthcare systems benefit from a more econometric approach? 

Adopting an econometric approach is useful to reveal broad patterns, isolate the effects of specific factors, and carry out projections. This type of approach must be done in conjunction with expert knowledge of local conditions.

What is the importance of taking epidemiological data into account in the context of international policymaking? 

Deming said that “without data, you are just another person with an opinion”. Data are essential to guide domestic and international policymaking. Lots of data still need to be produced, in order to strengthen surveillance systems.

Do you consider developed countries’ decision to donate COVID-19 vaccines a step towards achieving a GPG (Global Public Good), and do you see this becoming more commonplace?

Some people have argued that the current pandemic is a rehearsal for the coming climate change crisis. It is essential that developed countries stop acting as if they live on a different planet where bad things do not happen to them. An unfortunate advantage of global crises is that even self-interested rich countries contribute to the Global Public Good. However more needs to be done. Donating vaccines is an encouraging sign.

Do you believe the current pandemic will encourage a more global view of public health concerns and their associated impact on economies? 

This is a tough question! We have been warned repeatedly about the risks of emerging infectious diseases. But, unfortunately, we did not act to prevent global pandemics from happening. One may hope that we will draw out the right lessons from the current pandemic. However, I am skeptical. For policymakers, the future always seems far away and purely national issues much more pressing than uncertain existential risks.

What value did having access to global data add to your study?

As an applied economist, I value excellent data on a novel and interesting issue more than anything else. The GIDEON database allowed me to publish in an excellent journal and, most importantly, carefully model the spatial diffusion of infectious diseases in a globalized world.

How would you have gone about collecting the outbreaks data if the GIDEON database did not exist? 

One possibility would have been to exploit the Global Burden of Disease data. However, despite the provider’s best efforts, the reliability of these data remains uncertain, and diseases are aggregated in relatively coarse categories.

In your article, you mentioned the GIDEON database is under-exploited – do you believe it could further contribute to the field of Economics and how? 

Infectious diseases have now become a hot topic in Economics. For various reasons, including data availability, the effects of many diseases were neglected. I hope that my use of the GIDEON database will alert researchers to this incredible information source and encourage more epidemiological research.

Click here to read the open-access article Spatial dynamics of major infectious diseases outbreaks: A global empirical assessment

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Alkhurma, Botulism, Cryptococcus, and more. Or check out our global status updates on countries like Syria, Trinidad and Tobago, Uruguay, and more!

The post Disease Outbreaks and Economics with Prof. Desbordes appeared first on GIDEON.

In 2019, a crew of nine pilots and astronauts broke a world record. They flew around the Earth in just 46 hours. More incredible is that they did not fly in a never-before-seen, advanced aircraft prototype. They flew a commercially available jet plane.

The future is already here.

It’s a Small World; It’s Getting Smaller by the Minute

Based on the new world record, it could take less than a weekend for an emerging infectious disease to spread all over the globe. And chances are, it may take a week or more before it gets detected based on the incubation period.

Unfortunately, healthcare providers at the front of infectious disease management face a significantly higher risk of infection. The risk extends beyond healthcare workers to their families and communities.

As the world grapples with the impact of COVID-19 and its mutations, it’s a good time to ask: What can health systems worldwide do to detect emerging infectious diseases imported from other countries early?

Think Beyond the Travel Ban

Recent research empirically demonstrated that local outbreaks of various Infectious Diseases could “quickly spread to other countries through the international movement of people and goods, with potentially disastrous health consequences [1].”

While this fact may not be news to clinicians and Infectious Disease specialists, the study shows a close spatial dependence between the health conditions in one country and another – a spillover effect. The study used GIDEON, a database covering all Infectious Disease outbreaks.

An epidemic in one country can become a pandemic in others – irrespective of travel and other physical barriers to entry. Studies of previous epidemics show that even a 90% travel restriction between countries merely delays the arrival of an emerging infection by a few weeks. Another study by Quilty et al. reported that airport-based screening measures to detect COVID-19 missed 46% of cases because of the incubation period [2].

So, while a travel ban and thermal screening can help a country buy some time to prepare for an outbreak, epidemic, or pandemic, they cannot stop or prevent a new infection from spreading to foreign shores.

Record Travel History as Standard Protocol

Travel has always been one of the fastest ways to introduce a pathogen to a new environment. And as two clinicians, Trish Perl and Connie Savor Price, argue in a recent ‘Annals of Internal Medicine’ article, travel history must be treated as the fifth vital sign in emergency rooms and all physician evaluations [3].

The doctors make a strong case that including a patient’s travel history as part of a vital signs check can “help put symptoms of infection in context and trigger us to take a more detailed history, do appropriate testing, and rapidly implement protective measures.”

Monkeypox in the UK, 2021

For example, in May 2021, the World Health Organization was notified by the United Kingdom of a confirmed case of monkeypox in an individual who had just traveled from Nigeria. Monkeypox has an incubation period of six to thirteen days, but according to WHO, it can range anywhere from five to twenty-one days. Eventually, the infection spread to another family member, and they were isolated. Differential diagnosis considerations for monkeypox include chickenpox, measles, bacterial infections, scabies, syphilis, and medication-associated allergies. In such a case, taking the patient’s travel history can help healthcare workers take the necessary precautions before the PCR results.

COVID-19 in the United States, 2019

The first case of COVID-19 in the US was reported in Washington when the patient returned from Wuhan, China. Based on the patient’s travel history and symptoms, healthcare professionals could isolate and send clinical specimens to be tested by the CDC overnight. Hospitals in the United States were already on alert for patients from Wuhan presenting with symptoms, and testing could be prioritized accordingly.

Ebola in the United States, 2014

Let’s look at an example where a patient’s travel history would have helped protect healthcare professionals. In 2014, a man traveled from West Africa and admitted himself into a hospital in Dallas with fever, abdominal pain, dizziness, headache, and nausea. Without an integral piece of the puzzle – his travel history – he was treated for sinusitis and sent home. The hospital suspected Ebola only when he returned three days later with persistent fever, abdominal pain, and diarrhea. Unfortunately, within this time, this patient had infected healthcare professionals, ambulance transport personnel, and the patient’s caregivers.

Monkeypox and Ebola are not as contagious as COVID-19 and its variants, and Ebola is not contagious until symptoms appear, making containment easier. But emerging infectious diseases and their variants might be.

Infectious Disease specialists, clinicians, researchers, and medical librarians must be vigilant against the next outbreak. Epidemiological data is integral in facilitating improved clinical decisions and saving lives.

Identify Initial Cases of Known Diseases in New Settings

In a GIDEON survey of 363 clinicians in the US, UK, and Canada, 35% said they would consult a colleague for a second opinion before making clinical decisions. As a close second, 30% indicated that they trust their judgment. This means that 65% of the survey respondents trusted human judgment over Point-of-Care tools.

But the stakes are higher when dealing with highly transmissible emerging infections. The importance of first-time diagnosis accuracy is compounded due to the rising urgency to prevent the next epidemic or pandemic.

Consider the dramatic difference in transmission rates between SARS-CoV-2 and its variants:

• The B.1.1.7, the ‘Alpha’ SARS-CoV-2 variant, is 43% to 90% more transmissible than its predecessor and led to a surge in hospitalizations across the UK and 114 more countries in a mere few months [4].
• 1.617.2 or the ‘Delta’ variant is estimated to be 40% to 60% more infectious than the Alpha, estimated by disease modelers at Imperial College, London, with an R₀ as high as 8 [5].

Here are some comparisons of how newer, emerging pathogens and their variants compare to older, Infectious Diseases.

In other words, an outbreak may already be well underway before an Infectious Disease specialist is consulted for assistance on differential diagnosis or a medical librarian is requested for location-specific disease symptoms.

As pathogens mutate, traditional methods of differential diagnosis need an upgrade. Clinicians, Infectious Disease specialists, and researchers need data from local outbreaks anywhere in the world at their fingertips to help drive decision-making and advance the global effort against Infectious diseases.

Use a Differential Diagnosis (DDx) Tool like GIDEON’s First Case Scenario to Identify Infectious Diseases – Faster and More Accurately

Drs Perl and Price champion the need for greater access to digital resources that integrate electronic health records with patient travel histories and can “suggest specific diagnoses in febrile returning travelers.”

One of the more well-known DDx tools is GIDEON, with its First Case Scenario feature, created in partnership with the World Health Organization (WHO) after the West Nile Fever outbreak in the United States.

Using a DDx platform such as GIDEON helps:

• narrow down possibilities,
• lead to a faster result,
• reduce the margin of error at the point of care, and
• elevates peer-to-peer knowledge sharing on a global scale

Why is this important? Because, for example, in respiratory viral illnesses, early detection is the critical step to mitigate disease transmission but is often delayed [3]. Depending on the type of pathogen, this could lead to a more significant number of hospitalizations, more morbidity, a burden on healthcare systems, and have significant ramifications on a country, its people, and the economy.

Asking patients about their travel history can help prevent emerging infectious diseases introduction into the country

Having a differential diagnosis platform that incorporates a patient’s travel history can greatly affect how the world manages emerging infectious diseases.

Here’s an example. Suppose a patient presents with elevated body temperature, severe headache, chills, myalgia, diarrhea, and malaise.

These are nonspecific presentations and could be representative of a variety of diseases.  With international transmission now the norm, no clinician can be expected to track every emerging disease and its symptoms.

Example: Diagnosing Ebola Using a DDx Platform

Step 1: Focusing on most likely diseases based on symptoms and travel information
Entering a patient’s symptoms and the locations and dates of travel in a tool like GIDEON’s Bayesian analysis-driven Probability engine can help identify what diseases are most likely to correspond to the data entered. The illustration below shows Ebola as a high probability based on the patient’s symptoms and travel location.

Step 2: Conduct a differential diagnosis
The screenshot of the First Case Scenario feature below shows a 95% probability that the patient has Ebola. What if there were fewer symptoms at presentation, the likelihood of Ebola was 65%, and another disease was 25% probable? You could conduct a differential analysis by comparing the two disease symptoms on the platform, download the comparison, and order the requisite laboratory tests to confirm.

Step 3: First Case Scenario

Imagine it is 2014, and you haven’t heard of Ebola. A patient walks in with the symptoms listed above. You enter the symptoms and the patient’s travel history. Using GIDEON’s First Case Scenario, you can determine how likely it is that your patient is the first in the country to present with Ebola.

Illustration of diagnosing Ebola in a Point-of-Care setting (Screenshot: GIDEON First Case Scenario DDx tool)

Train an Army of Global Clinicians to Battle Infectious Diseases

Based on a GIDEON survey of 230 clinicians in the US, UK, and Canada, while clinicians were open to using a DDx tool to help diagnose Infectious Diseases, a lack of budget was the primary reason they did not.

One physician said, “I would use them every day if my institution would offer them.”

But an interactive platform with a robust database of Infectious Disease symptoms that incorporates patient locations, exposure to disease-causing elements, and comparisons between two or more similar diseases can offer benefits beyond what a seasoned clinician can accomplish.

It can train the next generation of Infectious Disease-fighting doctors and healthcare professionals. For example, take GIDEON’s step-by-step Bayesian analysis toolkit. Teaching institutions, medical librarians, medical students, residents, researchers, and more can use DDx tools to help hone their diagnoses of emerging and well-known infectious diseases.

The tool helps you list symptoms, patient travel information (if any), and any exposure to disease-causing elements (if known). For example, the patient ate chicken in a region that recently had a Salmonella outbreak.

The tool offers a list of probable diseases in descending order of probability. It helps that the tool is dynamic because what if the patient forgot a symptom and told you about it later? A new list of probable diseases is re-calculated automatically. An added benefit is that the DDx tool is integrated with the First Case Scenario to determine if a patient’s symptoms are the first in a specific location.

Health systems, medical colleges, and universities may benefit greatly from such a diagnostic solution.

Conclusion

War often provides an opportunity for innovation. After all, the internet was invented because computers at the time were enormous, and it was incredibly difficult to physically transport military intel from the United States to soldiers deployed around the world [6]. And clinicians are actively in a battle against the spread of infectious pathogens.

A global platform that offers timely location-specific intelligence about emerging infectious diseases and helps speed up clinical decisions is invaluable to future-proof the world against outbreaks, epidemics, and pandemics and save thousands of lives.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence. You can also review our eBooks on Alkhurma, Botulism, Cryptococcus, and more. Or check out our global status updates on the World and countries like Uzbekistan, Western Sahara, Zimbabwe, and more!

References

[1] R. Desbordes, “Spatial dynamics of major Infectious Diseases outbreaks: A global empirical assessment,” J. Math. Econ., vol. 93, no. 102493, p. 102493, 2021.

[2] B. J. Quilty, S. Clifford, S. Flasche, R. M. Eggo, and CMMID nCoV working group, “Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV),” Euro Surveill., vol. 25, no. 5, 2020.

[3] T. M. Perl and C. S. Price, “Managing emerging Infectious Diseases: Should travel be the fifth vital sign?” Ann. Intern. Med., vol. 172, no. 8, pp. 560–561, 2020.

[4] N. G. Davies et al., “Estimated transmissibility and impact of SARS-CoV-2 lineage B.1.1.7 in England,” Science, vol. 372, no. 6538, p. eabg3055, 2021.

[5] Scientific Advisory Group for Emergencies, “Imperial College London: Evaluating the roadmap out of lockdown – modelling Step 4 of the roadmap in the context of B.1.617.2 (Delta), 9 June 2021,” Gov.uk, 14-Jun-2021. [Online] [Accessed: 15-Jun-2021].

[6] B. Tarnoff, “How the internet was invented,”  The Guardian, 15-Jul-2016.

The post How Epidemiology Can Help Clinicians on the Frontline appeared first on GIDEON.

Food quality control expert inspecting groceries in the laboratory

Since 2019, World Food Safety Day is celebrated each year on the 7th of June,  to promote awareness regarding the need to develop and maintain food safety standards. These efforts are being done both to reduce the burden of foodborne disease and to minimize its impact on socio-economic systems.

Foodborne diseases constitute a major health issue worldwide. The World Health Organization (WHO) estimates that approximately 10% of the global population is infected by foodborne pathogens each year (1). Similar to other diseases, the severity of the foodborne illness varies with the type and the amount of exposure to the causative microorganism or germs, as well as the disease-fighting potential of the affected individual.

Clinical Presentation of Foodborne Diseases

Foodborne illnesses might manifest as acute diarrhea, nausea, etc., which usually resolves within 7 to 10 days; or as chronic and potentially fatal diseases such as botulism or typhoid fever.

Botulism, a common and potentially fatal disease, is caused by Clostridium botulinum. Signs and symptoms usually appear within 18 to 36 hours of food ingestion Bacterial toxins can persist in the patient’s blood for up to 12 days. Common findings include respiratory failure and neurological symptoms, such as blurred vision, paralysis, etc. (2). 

Foodborne cases of botulism in the United States 1979-2019

Prevention and Management of Foodborne Illnesses

Contamination of food or food products can occur at various stages of production, including growth, processing, transportation, or storage. Thus, there is a critical need to adopt appropriate measures that correspond to these variable conditions to maximize food safety and minimize the transmission of foodborne illnesses.

1.     Decontamination of Fresh Produce

With rapid globalization, fresh produce is now available worldwide throughout the year in the form of frozen food.  Fresh produce must undergo proper decontamination before being frozen – to prevent such diseases as norovirus infection and hepatitis A (3, 4). Some of the common techniques used for decontamination include (5):

a.     Application of antibiotics during the growth stage

b.     Proactive sampling for detection of pathogens

c.     Bacteriocins (bacteria-generated toxins to kill the competitive strains)

d.     Antimicrobial natural products and nanoparticles

e.     Bacteriophages

f.      Irradiation 

Alternatively, consumers might receive probiotics and relevant vaccines to protect them from relevant foodborne illnesses.

2.     Development of Public Health Surveillance Systems

A competent public health surveillance system should be implemented by the governmental and related organizations to identify impending outbreaks in order to facilitate effective policies and goals (6, 7). Such systems help control and prevent extensive transmission by collecting and analyzing epidemiological and clinical data that provide guidelines to take appropriate measures.

3.     Prophylactic Measures for People with Increased Susceptibility to These Illnesses

People who are vulnerable to foodborne infections, such as older adults, infants – and individuals with prior diseases of the immune system, liver, gastrointestinal tract, etc. should be particularly vigilant and observe preventive measures (8) including: 

a.   Adherence to a low-microbial diet and avoidance of undercooked meat, unpasteurized milk, etc.

b.  Consumption of  bottled natural water

c.   Infants should be preferably given sterile ready-to-eat formula; powdered formula should be reconstituted in boiling water and given in boiled water-  sterilized bottles

d.  Antimicrobial may be administered prophylactically during transplantation and other high-risk treatments.

4.     Food Safety Measures for Health

In general, people should adopt safe food practices wherever they cook and consume food or food products (9). The cooking utensils/surfaces should be properly cleaned and sanitized. Raw and undercooked foods should be stored separately to avoid cross-contamination. Food should be cooked or reheated thoroughly, meats and seafood should be cooked to appropriate temperatures. Cooked food should be stored at < 5°C, and not for prolonged periods. Only clean, purified water should be used for cooking food to minimize any chances of waterborne infection. Raw fruits and vegetables should be properly washed before consumption.

Raw fruits and vegetables should be properly washed before consumption.

At the Public Health level, comprehensive integration of government-issued guidelines and self-monitoring are needed to prevent and control foodborne illnesses.

References

1.     “Foodborne diseases”, World Health Organization. [Online]
2.     “Botulism”, GIDEON Informatics, Inc, 2021 [Online]
3.     Nasheri N, Vester A, Petronella N. Foodborne viral outbreaks associated with frozen produce. Epidemiol Infect. 2019 Oct;147:e291. doi: 10.1017/S0950268819001791.
4.     Chapman B, Gunter C. Local Food Systems Food Safety Concerns. Microbiol Spectr. 2018 Apr; 6(2). doi: 10.1128/microbiolspec.PFS-0020-2017.
5.     Yang SC, Lin CH, Aljuffali IA, Fang V. Current pathogenic Escherichia coli foodborne outbreak cases and therapy development. Arch. Microbiol. 2017 June; 199(6): 811-825. doi.org/10.1007/s00203-017-1393-y.
6.     Ward H, Molesworth A, Holmes S, Sinka K. Public health: surveillance, infection prevention, and control. Handb Clin Neurol. 2018; 153:473-484. doi: 10.1016/B978-0-444-63945-5.00027-1.
7.     Hoelzer K, Moreno Switt AI, Wiedmann M, Boor KJ. Emerging needs and opportunities in foodborne disease detection and prevention: From tools to people. Food Microbiol. 2018 Oct; 75:65-71. doi: 10.1016/j.fm.2017.07.006.
8.     Lund BM, O’Brien SJ. The occurrence and prevention of foodborne disease in vulnerable people. Foodborne Pathog Dis. 2011 Sep; 8(9):961-73. doi: 10.1089/fpd.2011.0860.
9.     “Five keys to safer food manual”, World Health Organization [Online]

The post Preventing Foodborne Illness appeared first on GIDEON.

Vibrio cholerae (V. cholerae) is a species of Gram-negative facultatively anaerobic bacteria of curved rod-shaped with single polar flagella. V. Cholerae has been classified into approximately 200 serogroups. Strains belonging to serogroups O1 and O139 cause the vast majority of cholera cases (1).

Vibrio cholerae is found naturally in brackish riverine, estuarine, and coastal waters. Recognized hosts of the organism include algae, shellfish, chironomid egg masses, fish, waterfowl, amebae, and copepods (2). V. cholerae colonies can form biofilms on both biotic and abiotic surfaces – including on shells, zooplankton, macroalgae, ship hulls, and plastic pollution (3-5). 

Cholera Transmission and Disease Severity 

Cholera is primarily transmitted through the consumption of fecally contaminated water and food. Foodborne outbreaks are most frequently linked to fish, shellfish, crabs, oysters, clams, rice, millet gruel, and vegetables (6).

Most V. cholerae infections are asymptomatic or mild in nature. Individuals with asymptomatic infections may still shed bacteria in their feces and infect others (7). Approximately 10% of V. cholerae infections will progress to severe disease (8). In endemic settings, the most severe infections occur in children, while in epidemic settings, severe disease occurs in adults as frequently as it does in children (9). 

Individuals with blood type O are more likely to suffer from severe V. cholerae infection (10). The use of drugs that reduce stomach acid, such as antacids, histamine receptor blockers, and proton pump inhibitors, also increases the risk of severe infection (11). 

Vibrio cholerae isolated from feces obtained from a patient with profuse diarrhea who had traveled to India. Photo courtesy of Nathan Reading

Signs and Symptoms of Cholera

Cholera has an average incubation period of 1-5 days. Patients will experience a sudden onset of painless, watery diarrhea that may be accompanied by vomiting. The diarrhea is often characterized as having a “rice water” appearance and fishy odor. Fever is uncommon in adults, but often present in children (12).

In severe cases, dehydration may lead to the rapid progression to acidosis and electrolyte imbalance. Coma may occur. Without the replacement of fluids and electrolytes, hypovolemic shock and death ensue (12).

If left untreated, cholera has a 25-50% mortality rate. Proper treatment reduces the mortality rate to less than 1% (13).

Diagnosis and Treatment of Cholera

Cholera is diagnosed via stool culture. When a case is suspected, healthcare and medical laboratory personnel should follow stool precautions.

Mild and moderate cases of cholera can be successfully treated with oral rehydration salts, while severe cases require rehydration with intravenous fluids (14). The World Health Organization (WHO) recommends reserving antibiotics as a treatment for severe cases only, as antibiotic use has no proven effect on controlling the spread of the disease and may contribute to antimicrobial resistance (15). In severe cases, tetracycline, doxycycline, azithromycin, erythromycin, or ciprofloxacin may be used (12). Most people who recover from V. cholerae infection incur long-lasting immunity (16).

Cholera Prevalence

Cholera originated in India and spread across the world during the 19th century (17). Since that time, there have been seven cholera pandemics, including one that is ongoing today (18). 

Currently, approximately 1.3 billion people are at risk for cholera in endemic countries. An estimated 2.86 million cholera cases occur annually, resulting in an estimated 95,000 deaths (19).

Over the last decade, the countries reporting the most cases of cholera have included Yemen, Somalia, the Democratic Republic of Congo, Mozambique, Bangladesh, and Haiti. If you have a GIDEON account, click here to explore the Cholera outbreak map. Cholera is exceedingly rare in Europe and the United States.

Cholera cases by region, 1953 – 2018

Cholera Prevention

When traveling to an area where cholera is endemic, precautions should include adherence to proper hand hygiene, drinking only bottled water, and avoiding uncooked food.

Ongoing worldwide efforts to end the current cholera pandemic center on increasing access to clean water and sanitation and expanding accessibility to existing cholera vaccines.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

References 

(1) Morris, “Infections due to non-O1/O139 Vibrio cholerae“, Uptodate.com, 2019. [Online]. 

(2) “Cholera: Environmental Reservoirs and Impact on Disease Transmission”, One Health, pp. 149-165, 2014. Available: 10.1128/microbiolspec.oh-0003-2012

(3) B. Wucher, T. Bartlett, M. Hoyos, K. Papenfort, A. Persat, and C. Nadell, “Vibrio cholerae filamentation promotes chitin surface attachment at the expense of competition in biofilms”, Proceedings of the National Academy of Sciences, vol. 116, no. 28, pp. 14216-14221, 2019. Available: 10.1073/pnas.1819016116

(4) C. Lutz, M. Erken, P. Noorian, S. Sun and D. McDougald, “Environmental reservoirs and mechanisms of persistence of Vibrio cholerae”, Frontiers in Microbiology, vol. 4, 2013. Available: 10.3389/fmicb.2013.00375 

(5) J. Moskow, “What Do Plastics Have To Do With Infectious Diseases and the Immune System?“, GIDEON Informatics, Inc, 2021. [Online].

(6) G. Rabbani, W. Greenough. “Food as a vehicle of transmission of cholera”, J Diarrhoeal Dis Res, vol. 17, no. 1, pp. 1-9, 1999

(7) J. Lewnard, M. Antillón, G. Gonsalves, A. Miller, A. Ko and V. Pitzer, “Strategies to Prevent Cholera Introduction during International Personnel Deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak”, PLOS Medicine, vol. 13, no. 1, p. e1001947, 2016. Available: 10.1371/journal.pmed.1001947

(8) “Cholera – Vibrio cholerae infection: General Information“, Centers for Disease Control and Prevention (CDC0, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), 2020. [Online]

(9) J. Harris, R. LaRocque, F. Qadri, E. Ryan, and S. Calderwood, “Cholera”, The Lancet, vol. 379, no. 9835, pp. 2466-2476, 2012. Available: 10.1016/s0140-6736(12)60436-x

(10) J. Harris and R. LaRocque, “Cholera and ABO Blood Group: Understanding an Ancient Association”, The American Journal of Tropical Medicine and Hygiene, vol. 95, no. 2, pp. 263-264, 2016. Available: 10.4269/ajtmh.16-0440

(11) S. Handa, “Which classes of medications increase the risk of cholera infection?“, Medscape.com, 2018. [Online].

(12) “Cholera“, GIDEON Informatics, Inc, 2021. [Online]. 

(13) J. Fournier and M. Quilici, “Choléra”, La Presse Médicale, vol. 36, no. 4, pp. 727-739, 2007. Available: 10.1016/j.lpm.2006.11.029 

(14) “WHO | WHO position paper on Oral Rehydration Salts to reduce mortality from cholera“, Who.int, 2021. [Online]

(15) “Cholera“, Who.int, 2021. [Online]. 

(16) J. Harris, “Cholera: Immunity and Prospects in Vaccine Development”, The Journal of Infectious Diseases, vol. 218, no. 3, pp. S141-S146, 2018. Available: 10.1093/infdis/jiy414

(17) D. Lippi, E. Gotuzzo and S. Caini, “Cholera”, Paleomicrobiology of Humans, pp. 173-180, 2016. Available: 10.1128/microbiolspec.poh-0012-2015 

(18) S. Handa, “What are the 7 pandemics of cholera“, Medscape.com, 2018. [Online].

(19) M. Ali, A. Nelson, A. Lopez and D. Sack, “Updated Global Burden of Cholera in Endemic Countries”, PLOS Neglected Tropical Diseases, vol. 9, no. 6, p. e0003832, 2015. Available: 10.1371/journal.pntd.0003832

The post All You Need to Know About Cholera appeared first on GIDEON.

Inoculating eggs with yellow fever vaccine, 1942. USPHS (the United States Public Health Service) Rocky Mountain Laboratory, Hamilton, Montana. Photographer: John Vachon

What is Yellow Fever and What are the Symptoms?

The yellow fever virus, a flavivirus, is transmitted via the bites of various mosquito species. The disease has an average incubation period of 3 to 6 days. The clinical presentation of yellow fever can vary greatly, ranging from a self-limited flu-like illness to overwhelming hemorrhagic fever – with a case fatality rate of 50%. Approximately 55% of infections are asymptomatic, 33% are categorized as mild, and 12% severe (1).

Yellow fever generally manifests with symptoms like the acute onset of fever, headache, backache, myalgia, and vomiting. Conjunctival infection may be seen, accompanied by facial flushing, relative bradycardia (Faget’s sign), and leukopenia. In some cases, fever and other symptoms may be remitted for a few hours to several days. Upon return of symptoms, icteric hepatitis and a hemorrhagic diathesis may follow with epistaxis, bleeding from the gums and gastrointestinal tract, and petechial and purpuric hemorrhages. Weakness, prostration, protracted vomiting, and albuminuria may also be noted as symptoms. At this stage, patients will experience renal failure, myocardial dysfunction, necro-hemorrhagic pancreatitis, and seizures.

Yellow fever virus has a case fatality rate of 10 to 60% within 7 days of disease onset (1).

The Origin and Spread of The Disease

Phylogenetic analyses indicate that yellow fever originated in Africa within the last 1,500 years. Its spread to the Americas coincided with the trans-Atlantic slave trade that began during the 16th century. It is likely that mosquitoes carrying the disease were imported into the Americas via slave ships (2). Significant outbreaks followed as the virus was introduced into populations with no pre-existing immunity. During the 18th and 19th centuries, approximately 25 major outbreaks claimed the lives of hundreds of thousands in New York City, Philadelphia, Baltimore, and New Orleans (3). Yellow fever transmission also occurred in Europe during this time, with notable outbreaks occurring at Spanish, Portuguese, French, and British seaports (4).

It is estimated that for every soldier who died in battle during the Spanish-American War, 13 died of the illness (5). It also killed many thousands during the construction of the Panama Canal. 

William C. Gorgas (1854-1920), on the site of Panama Canal construction. As a U.S. Army surgeon during the Spanish American War, he established methods for eradicating mosquitoes hence reducing yellow fever and malaria among soldiers in Cuba. In 1904 he applied these techniques to control disease among the Panama Canal workers. Ca. 1910.

Development of a Vaccine

Early attempts to develop a vaccine for yellow fever resulted in the deaths of several test subjects and researchers. In 1900, a team led by Major Walter Reed traveled to Cuba to study the disease. At this point, the medical community was largely dismissive of the theory that mosquitos were the vectors of transmission for the disease. Working under the assumption that the mosquito theory was indeed incorrect, Reed’s team began experimenting with mosquitos and volunteers. After receiving criticism about using human test subjects, some team members decided to instead experiment on themselves. Unfortunately, this resulted in the death of physician-scientist Dr. Jesse Lazear – but with his death, the mosquito theory began to gain acceptance (6). 

Despite the death of Dr. Lazear, research on human test subjects continued. The Reed team conducted a second and third set of mosquito experiments, offering financial compensation in the form of gold to study participants (6). After learning that none of these latest Reed study participants had died, Cuban physician, Dr. John Guiteras began his own experiments. Unfortunately, three of his 42 test subjects succumbed to the illness, and with this, the research in Cuba came to a halt (7).

Subsequent efforts to control yellow fever centered on reducing mosquito populations as opposed to vaccine development, until 1918 when the Rockefeller Foundation began conducting research. Within a year, Japanese scientist Dr. Hideyo Noguchi, who was working with the Foundation, announced that he had successfully developed a yellow fever vaccination. Individuals in the United States, Latin America, and the French African colonies began receiving his vaccine, but the legitimacy of the studies leading to its development was soon called into question, and ultimately it was pulled (7).

The Rockefeller Foundation continued its efforts, and in 1925, they sent investigators to Lagos to determine if the African and South American diseases were caused by the same pathogen. Unfortunately, this trip resulted in three more investigators contracting and dying from yellow fever, including Dr. Noguchi. Nonetheless, the Rockefeller Foundation persisted, and a few years later, another candidate of vaccination was developed – this time from efforts led by Dr. Max Theiler (7).

Despite the history of physician deaths related to experimentation, Brazilian physician Dr. Bruce Wilson volunteered to receive the first dose of the Theiler vaccination. It was designated a success, and mass production began. Soon after, the Pasteur Institute developed their own version, and for the next several years, the Rockefeller Foundation version was used in the West as well as in England, and the Pasteur Institute vaccine was used in France and its African colonies (7).

During World War II, the Rockefeller Foundation vaccine was given to almost all US soldiers. Unfortunately, it contained blood serum, and vaccination efforts resulted in approximately 330,000 soldiers contracting hepatitis B virus infection (8). Blood serum was subsequently removed as a component of the vaccine, and in 1953 a yellow fever vaccine was licensed for civilian use in the US (9). The use of the Pasteur Institute vaccine eventually ceased due to cases of postvaccinal encephalitis, but a variant of the Rockefeller foundation yellow fever vaccine is still used today. Dr. Theiler received the Nobel Prize in Physiology or Medicine for his critical role in its development.

What is Happening with the Illness Today?

Today, the Centers for Disease Control and Prevention (CDC) recommends vaccination against yellow fever for individuals 9 months and older and who are traveling to or living in areas at risk in Africa and South America (10). It is a live attenuated vaccine, and thus contraindicated in patients who are immunocompromised. It is highly effective, with a median seroconversion rate of 99% (range 81–100%) in clinical trials (11).

Yellow fever is currently estimated to affect 200,000 people each year, resulting in 30,000 deaths, with 90% of cases occurring in Africa (12). Recent outbreaks have occurred in Brazil, Angola, Nigeria, and the Democratic Rep. of Congo. If you have a GIDEON account, click here to explore the Yellow Fever outbreak map. There are ongoing efforts to expand access to immunization in these regions, as well as to implement additional vector control programs. 

The last outbreak in the United States occurred in 1905 (13). Yellow fever outbreaks ceased in Europe after World War II, when, for unknown reasons, the Aedes aegypti mosquito disappeared (14).

The absence of the disease in Asia is not fully understood. Some have speculated that differences in mosquito species may play a role. Another theory is that there may be a cross-immunity between yellow fever and other flaviviruses endemic to Asia, such as dengue fever. A third theory is that it has simply never been introduced into Asia (2).

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

References

(1) “Yellow fever“, GIDEON Informatics, Inc, 2021. [Online]

(2) Cathey and J. Marr, “Yellow fever, Asia and the East African slave trade”, Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 108, no. 5, pp. 252-257, 2014. Available: 10.1093/trstmh/tru043 

(3) F. Douam and A. Ploss, “Yellow Fever Virus: Knowledge Gaps Impeding the Fight Against an Old Foe”, Trends in Microbiology, vol. 26, no. 11, pp. 913-928, 2018. Available: 10.1016/j.tim.2018.05.012 

(4) M. Morillon, B. Marfart, and T. Matton, “Yellow fever in Europe in 19th Century”, Ecological Aspects of Past Settlement in Europe. P. Bennike, pp. 211-222, 2002.

(5) Staples, “Yellow Fever: 100 Years of Discovery”, JAMA, vol. 300, no. 8, p. 960, 2008. Available: 10.1001/jama.300.8.960 

(6) “Politics of Participation: Walter Reed’s Yellow-Fever Experiments”, AMA Journal of Ethics, vol. 11, no. 4, pp. 326-330, 2009. Available: 10.1001/virtualmentor.2009.11.4.mhst1-0904

(7) J. Frierson. “The yellow fever vaccine: a history”, Yale J Biol Med, vol. 83, no. 2, pp. 77-85, 2010

(8) M. Furmanski. “Unlicensed vaccines and bioweapon defense in World War II”, JAMA, vol. 282, no. 9, p. 822, 1999

(9) “Historic Dates and Events Related to Vaccines and Immunization“, Immunize.org, 2021. [Online]

(10)”Yellow Fever Vaccine Recommendations“, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD), 2021. [Online]

(11) J. Staples, A. Barrett, A. Wilder-Smith and J. Hombach, “Review of data and knowledge gaps regarding yellow fever vaccine-induced immunity and duration of protection”, npj Vaccines, vol. 5, no. 1, 2020. Available: 10.1038/s41541-020-0205-6 

(12) “Yellow Fever“, Centers for Disease Control and Prevention, Global Health, 2018. [Online]

(13) K. Patterson, “Yellow fever epidemics and mortality in the United States, 1693–1905”, Social Science & Medicine, vol. 34, no. 8, pp. 855-865, 1992. Available: 10.1016/0277-9536(92)90255-o 

(14) “Facts about yellow fever“, European Centre for Disease Prevention and Control, 2021. [Online]

The post Yellow Fever: Past and Present appeared first on GIDEON.

You may know they save lives, but have you ever wondered how vaccines work? As mass vaccination programs in response to the COVID-19 pandemic are underway, there is a heightened interest in understanding vaccines and their mechanism of action.

Vaccines stimulate the immune system to recognize and respond to specific pathogens. This is part of why people refer to being immune to disease after getting vaccinated. Differing vaccines accomplish this through a variety of mechanisms. Vaccines can be divided into five basic categories: live attenuated vaccines, inactivated vaccines, subunit vaccines including toxoids, mRNA vaccines, and viral vector vaccines.

Live Attenuated Vaccines

Live attenuated vaccines contain live viruses or bacteria that have been weakened to reduce virulence. Following ingestion or injection, the body mounts an immune response that is similar to what would occur if it were to encounter the natural disease. Since the pathogens used in live attenuated vaccines have been weakened, they cause only mild symptoms – or no symptoms at all. Live attenuated vaccines generally provide the longest-lasting immunity of any vaccine type.

Examples of live attenuated viral preparations include measles, mumps, rubella, varicella, rotavirus, yellow fever, oral polio vaccine, and intranasal influenza vaccine. Live attenuated bacterial vaccines include the BCG vaccine for tuberculosis and the oral cholera vaccine. In general, viral vaccines have greater efficacy than bacterial vaccines.

The eradication of smallpox was accomplished through a live attenuated vaccine, which contained a related virus (vaccinia). In the veterinary world, widespread use of a live attenuated vaccine led to the eradication of Rinderpest, also known as ‘cattle plague’, caused by a morbillivirus of the family Paramyxoviridae. 

Live attenuated vaccines are generally contraindicated in pregnant women and immunocompromised patients, such as those receiving immunosuppressive therapy or living with HIV/AIDS or congenital immunodeficiency. 

It is extremely rare for a live attenuated vaccine virus to mutate into a more virulent form and cause disease. Cases of this phenomenon have been documented with oral polio vaccine, at a reported rate of one case per 750,000 children receiving their first dose (1). As a result of these rare instances, in many countries (including the United States), the oral polio vaccine is no longer used and has been replaced by inactivated preparations.

How Inactivated Vaccines Work

Inactivated vaccines, also known as killed vaccines, prime the immune system with bacteria or viruses that have been inactivated to remove all virulence. They cannot cause the disease they protect against and are generally considered safe for immunocompromised and pregnant patients. The protection provided by inactivated vaccines do not usually last as long as that provided by live attenuated vaccines, and booster doses are often recommended. 

Examples of inactivated vaccines include hepatitis A, rabies, intramuscular influenza, intramuscular polio, and variants of the pertussis vaccine. Several inactivated SARS-CoV-2 vaccines have been developed, including China’s “Sinovac”, India’s “Covaxin”, and Russia’s “CoviVac”.

Inactivated vaccine mechanism of action

What Are Subunit Vaccines and How Do They Work?

Subunit vaccines contain fragments of a pathogen (i.e., a polypeptide or polysaccharide) often bound to other molecules. As with inactivated vaccines, these cannot produce the disease itself and are generally considered safe for immunocompromised and pregnant patients. Booster doses are often required.

Examples of subunit vaccines include hepatitis B, human papillomavirus (HPV), Haemophilus influenzae type B (HiB), herpes zoster, meningococcus B, pneumococcal, and one variant of the pertussis vaccine. Occasionally, the subunit used in these vaccines is an attenuated toxin (toxoid).  Examples of toxoid vaccines include tetanus and diphtheria.

There are several subunit vaccines for SARS-CoV-2 in various stages of clinical trials around the world.

Messenger RNA (mRNA) – a New Type of Vaccine

mRNA vaccines are a new type of vaccine and contain fragments of mRNA that encode a piece of protein from the pathogen of interest. After being vaccinated with such a vaccine, the body’s own cells incorporate the mRNA and produce the protein, which the immune system then recognizes as foreign. The Pfizer-BioNTech and Moderna COVID-19 vaccines are both mRNA vaccines. There are several additional mRNA vaccines currently in development. 

mRNA vaccine mechanism of action

What about Viral Vector Vaccines?

Viral vector vaccines use modified versions of viruses as “vectors” to deliver a nucleic acid of the pathogen of interest into the cell. Once inside the cell, the DNA is transcribed into mRNA, and the mRNA is translated into protein. The body then recognizes this protein as foreign and mounts an immune response, similar to that which occurs with mRNA vaccines. The Johnson & Johnson COVID-19 vaccine works in this manner.

Viral vector vaccine mechanism of action

Dr. Steve Berger on How Vaccines Work

GIDEON co-founder Dr. Steve Berger reflects on vaccines: “Vaccines continue to save millions of lives and have prevented untold misery to the human species. Although the effectiveness of individual vaccines may vary, and most may cause occasional side effects, the cost of non-vaccination – in both death and suffering – will always be much higher.”

Optimizing The Immune System

Proper nutrition, exercise, ample sleep, and adequate levels of Vitamin D have been shown to enhance the efficacy of vaccines as well as strengthen the immune system as a whole. So aside from being vaccinated, there are also things that you can do to keep your health a priority. Information on the immune system, building immunity, and more is critical for keeping your body optimized for combatting disease whether from bacteria or a virus. This is discussed in more detail in our blog: Strengthen Your Immune System.

The GIDEON Difference in Fighting Infectious Disease

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

References:

(1) “Poliomyelitis Prevention in the United States: Introduction of A Sequential Vaccination Schedule of Inactivated PoliovirusVaccine Followed by Oral Poliovirus Vaccine; Recommendations of the Advisory Committee on Immunization Practices (ACIP)“, Cdc.gov, 1997. [Online]

The post How Vaccines Work appeared first on GIDEON.

Staphylococcus aureus, 20,000X magnification. Courtesy of Frank DeLeo, NIAID

Staphylococcus aureus (S. aureus) is a facultative anaerobic, gram-positive coccus. S. aureus is part of the normal flora of the body, found in the skin, upper respiratory tract, gut, and genitourinary tract – and most commonly in the anterior nares. Twenty percent of individuals are persistent nasal carriers of S. aureus, and an additional thirty percent are intermittent carriers (1).

Under certain conditions, S. aureus can be pathogenic, causing a variety of infections, including skin conditions, pneumonia, gastroenteritis, endocarditis, osteomyelitis, septic arthritis, meningitis, bacteremia, and sepsis. Individuals at increased risk include patients with diabetes, cancer, HIV/AIDS, and other conditions that compromise the immune system. Intravenous drug users may introduce the bacteria into various tissues and/or the bloodstream. Hospitalization is in itself a risk factor for S. aureus infection.

Staphylococcus Aureus Skin infections

S. aureus can cause a diverse array of skin infections, including folliculitis, impetigo, furuncles, carbuncles, cellulitis, and abscesses. S. aureus is the most common cause of skin infection in individuals with eczema, and many presumed cases of “eczema” are, in fact, inflammatory reactions to colonization by S. aureus (2). 

S. aureus is the most common agent of surgical site infections (3), and a common cause of infection in burn patients. Animal bites, including bites from dogs and cats, can also lead to S. aureus skin infections.

Staphylococcal scalded skin syndrome, also known as “Ritter’s disease”, is caused by exotoxin-producing strains of S. aureus – and is characterized by diffuse erythematous cellulitis followed by extensive skin exfoliation (4). Fever is common, and patients are most often neonates, children, immunocompromised individuals, and individuals with severe renal disease. It is thought that the latter are at an increased risk due to a decreased ability to excrete the exotoxins in urine (5). Healthy adults rarely develop the syndrome, as a result of having antibodies to the exotoxins. Staphylococcal scalded skin syndrome is intraepidermal. Necrosis of the full epidermal layer may also occur as a result of S. aureus infection and is known as toxic epidermal necrolysis – a more severe form of the disease.

Various topical and systemic antibiotics can be used to treat S. aureus skin infections including beta-lactams, macrolides, and aminoglycosides. Treatment may be complicated by antibiotic resistance.

Staphylococcus Aureus Pneumonia 

S. aureus is identified in three percent of community-acquired bacterial pneumonia (6), and 18% of hospital-acquired pneumonia (7). S. aureus is a cause of secondary bacterial pneumonia associated with influenza, and influenza has been shown to increase the adherence of S. aureus to host cells (8). One study showed that 33% of children admitted to the PICU during the 2009 H1N1 pandemic had a secondary bacterial coinfection, with S. aureus being the most common pathogen (9). S. aureus is also frequently isolated from the respiratory tract of children with cystic fibrosis (10).

Staphylococcus aureus is one of the etiological agents of bacterial pneumonia

S.aureus can cause necrotizing pneumonia, characterized by necrosis, liquefaction, and cavitation of the lung parenchyma (11) – often accompanied by empyema and bronchopleural fistulae. Necrotizing pneumonia caused by community-acquired methicillin-resistant S. aureus (MRSA) strains which produce Panton valentine leukocidin (PVL) toxin has a mortality rate of 60% (12).

Treatment of pneumonia caused by S. aureus is based on testing for antibiotic susceptibility. Nafcillin, oxacillin, and cefazolin are often used to treat methicillin-sensitive S. aureus (MSSA), while vancomycin or linezolid is often used to treat MRSA (13).

Food Poisoning From Staphylococcus Aureus 

S.aureus is one of the most common causes of food-borne disease worldwide (14). Illness is characterized by a short incubation period (2h-4h), nausea, vomiting, intestinal cramping, and profuse watery, non-bloody diarrhea (15). The condition is generally self-limited, and symptoms typically resolve within 12 to 24 hours.

Staphylococcal food poisoning, outbreak-related cases and rates in the United States, 1952 – 2010

Toxic Shock Syndrome From Staphylococcus Aureus

S.aureus is the most common cause of toxic shock syndrome, a life-threatening syndrome resulting from staphylococcal toxin-1 (TSST-1). It is characterized by fever, hypotension, myalgia, macular erythema, desquamation (particularly of the palms and soles), and acute vomiting or diarrhea (16). Most cases are associated with the use of “super absorbent” tampons or staphylococcal wound infection. Case fatality rates of 5 to 10% are reported. The condition is generally treated with vancomycin in combination with clindamycin.

Staphylococcus Aureus Endocarditis

S.aureus is the leading cause of acute bacterial endocarditis. Of infections caused by S. aureus, endocarditis accounts for the highest mortality rates (17). Populations at high risk include IV drug users and patients with implanted medical devices such as prosthetic heart valves, grafts, pacemakers, and hemodialysis catheters (18). Treatment varies and depends on several factors, including antibiotic susceptibility, site of infection (left side versus right side), IV drug abuse status, and if a prosthetic valve is present (19).

Other Infections Caused By Staphylococcus Aureus

Staphylococcus aureus can also cause mastitis, urinary tract infections, osteomyelitis, meningitis, septic arthritis, and many infections associated with medical devices and implants.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.
You can also review our eBooks on Alkhurma, Botulism, Cryptococcus, and more. Or check out our global status updates on countries like Algeria, Canada, Iceland, and more!

References 

(1) Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, Nouwen JL. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005 Dec;5(12):751-62. doi: 10.1016/S1473-3099(05)70295-4.

(2) Nakamura Y, Oscherwitz J, Cease KB, Chan SM, Muñoz-Planillo R, Hasegawa M, Villaruz AE, Cheung GY, McGavin MJ, Travers JB, Otto M, Inohara N, Núñez G. Staphylococcus δ-toxin induces allergic skin disease by activating mast cells. Nature. 2013 Nov 21;503(7476):397-401. doi: 10.1038/nature12655. 

(3) Mellinghoff SC, Vehreschild JJ, Liss BJ, Cornely OA. Epidemiology of Surgical Site Infections With Staphylococcus aureus in Europe: Protocol for a Retrospective, Multicenter Study. JMIR Res Protoc. 2018 Mar 12;7(3):e63. doi: 10.2196/resprot.8177.

(4) “Staphylococcal scalded skin syndrome”, GIDEON Informatics, Inc, 2021. [Online].

(5) Ross A, Shoff HW. Staphylococcal Scalded Skin Syndrome. 2020 Oct 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. 

(6) Hageman JC, Uyeki TM, Francis JS, Jernigan DB, Wheeler JG, Bridges CB, Barenkamp SJ, Sievert DM, Srinivasan A, Doherty MC, McDougal LK, Killgore GE, Lopatin UA, Coffman R, MacDonald JK, McAllister SK, Fosheim GE, Patel JB, McDonald LC. Severe community-acquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season. Emerg Infect Dis. 2006 Jun;12(6):894-9. doi: 10.3201/eid1206.051141.

(7) Kollef MH, Micek ST. Staphylococcus aureus pneumonia: a “superbug” infection in the community and hospital settings. Chest. 2005 Sep;128(3):1093-7. doi: 10.1378/chest.128.3.1093.

(8) Morris DE, Cleary DW, Clarke SC. Secondary Bacterial Infections Associated with Influenza Pandemics. Front Microbiol. 2017 Jun 23;8:1041. doi: 10.3389/fmicb.2017.01041.

(9) Randolph AG, Vaughn F, Sullivan R, Rubinson L, Thompson BT, Yoon G, Smoot E, Rice TW, Loftis LL, Helfaer M, Doctor A, Paden M, Flori H, Babbitt C, Graciano AL, Gedeit R, Sanders RC, Giuliano JS, Zimmerman J, Uyeki TM; Pediatric Acute Lung Injury and Sepsis Investigator’s Network and the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Critically ill children during the 2009-2010 influenza pandemic in the United States. Pediatrics. 2011 Dec;128(6):e1450-8. doi: 10.1542/peds.2011-0774.

(10) Hurley MN. Staphylococcus aureus in cystic fibrosis: problem bug or an innocent bystander? Breathe (Sheff). 2018 Jun;14(2):87-90. doi: 10.1183/20734735.014718.

(11) Nicolaou EV, Bartlett AH. Necrotizing Pneumonia. Pediatr Ann. 2017 Feb 1;46(2):e65-e68. doi: 10.3928/19382359-20170120-02.

(12) Gillet Y, Vanhems P, Lina G, Bes M, Vandenesch F, Floret D, Etienne J. Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing Panton-Valentine leukocidin. Clin Infect Dis. 2007 Aug 1;45(3):315-21. doi: 10.1086/519263.

(13) Clark SB, Hicks MA. Staphylococcal Pneumonia. 2020 Oct 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. 

(14) Kadariya J, Smith TC, Thapaliya D. Staphylococcus aureus and staphylococcal food-borne disease: an ongoing challenge in public health. Biomed Res Int. 2014;2014:827965. doi: 10.1155/2014/827965.

(15) “Staphylococcal food poisoning”, GIDEON Informatics, Inc, 2021. [Online]

(16) “Toxic shock syndrome”, GIDEON Informatics, Inc, 2021. [Online]

(17) Fernández Guerrero ML, González López JJ, Goyenechea A, Fraile J, de Górgolas M. Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining the outcome. Medicine (Baltimore). 2009 Jan;88(1):1-22. doi: 10.1097/MD.0b013e318194da65.

(18) Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS; ICE Investigators. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005 Jun 22;293(24):3012-21. doi: 10.1001/jama.293.24.3012. 

(19) Bille J. Medical treatment of staphylococcal infective endocarditis. Eur Heart J. 1995 Apr;16 Suppl B:80-3. doi: 10.1093/eurheartj/16.suppl_b.80.

The post What is Staphylococcus aureus? appeared first on GIDEON.

written exclusively for gideononline.com by Jennifer Birch

Fungal infections are a rampant problem in America. According to the Center for Disease Control and Prevention (CDC), there were over 75,000 hospitalizations for fungal disease in 2017. However, this figure is most likely an underrepresentation, given that fungal infections go largely undiagnosed. Regardless, some of them can cause illness and even death if left untreated. Individuals should be aware of the signs, treatment options, and prevention methods for fungal infections.

What is a Fungal Infection?

Fungi cause fungal infections. Most relate this type of microorganism to mushrooms, but they also come in the form of mold, mildew, and yeast. When a harmful fungus comes into contact with your skin, especially through an open wound, it can cause an infection. Some types of fungi also release tiny spores into the air as a means of reproduction. Inhaling these spores can also cause a fungal infection to spread in your lungs.

Given that there are multiple types of fungi, it follows that there are also many different diseases that stem from the initial infection. One example is Candidiasis, which is caused by yeast – the most common cause of fungal infections worldwide. Other fungal diseases include dermatophytosis, endemic mycoses, and a whole slew of mold-based illnesses.

Regardless of the cause, fungal infections are usually characterized by redness, itching, irritation, and even swelling of the skin. It can be very uncomfortable for anyone who experiences it and must be treated immediately.

What are the Treatment Options?

Most fungal infections will go away with the use of over-the-counter treatments. These include antifungal creams, gels, sprays, and ointments.

However, if it doesn’t improve even after medication, it’s best to seek medical assistance. When visiting your local clinic, you will likely be attended to by a nurse knowledgeable in this area. Most specialist nurses have completed an RN to BSN program, which qualifies them as primary care professionals who can diagnose various conditions, including superficial fungal infections. Note down recommendations made by your nurse regarding treatment and future techniques for prevention against fungal infections.

However, if the infection becomes more serious, prepare to be directed to a dermatologist or an Infectious Disease specialist. After evaluating the area of infection, they will likely prescribe a more potent antifungal cream that you can’t get over the counter. For fungal infections that have begun to spread throughout your body, they might administer an antifungal injection and prescribe oral medication. Make sure to keep in touch with your doctor throughout the treatment process to ensure that the infection isn’t getting worse.

Prevention is Better than a Cure

Plenty of fungi thrives in hot and humid weather, especially mold. So, to prevent more fungal infections in the future, you need to ensure your home is clean and dry. Properly ventilate rooms, so moisture doesn’t build up inside. It’s also worth investing in air conditioning units and dehumidifiers to further improve air quality at home. Finally, should you find any mold or mildew growing in your house and deal with it immediately, so it doesn’t propagate further.

In addition to keeping your home clean, you should also practice good personal hygiene. This simply means wearing clean clothes and taking baths regularly. At the end of the day, protecting your home against fungus and keeping your body clean is the surest way to prevent fungal diseases.

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Alkhurma, Botulism, Cryptococcus, and more. Or check out our global status updates on countries like Algeria, Canada, Iceland, and more!

The post What to Do When Faced With a Fungal Infection at Home appeared first on GIDEON.

Most people are aware that plastics are harmful to the environment. They pollute soil, air, and water and disrupt our ecosystems. Few people, however, are aware of the influence plastics may have on the spread of infectious diseases and on the function of our immune systems.

Plastics as a Breeding Ground for Pathogens

Microbes struggle to survive on certain surfaces and thrive on others. Copper, for example, has anti-microbial properties (1); while plastic keeps some microbes alive longer than other common materials.

Influenza A and B viruses survive for longer periods on plastic surfaces than on cloth or paper (2). SARS-CoV-2 has been shown to survive longer on plastic than on glass, stainless steel, pigskin, cardboard, banknotes, cotton, wood, paper, tissue, or copper (3). Indeed, bacteria – and not only viruses – favor plastic. Methicillin-resistant Staphylococcus aureus (MRSA), for example, survives longer on plastic than on wood, glass, or cloth (4). There is thus a concern for plastics serving as fomites, especially in high-risk settings such as hospitals.

But what about the plastics polluting our oceans? Are these free from pathogens? There are actually such complex microbial communities found on the plastics in our ocean that the term “plastisphere” was coined (5). A 2019 study examined the plastisphere of plastic nurdles from five European beaches (6). Escherichia coli (E. coli) and Vibrio spp. were found colonizing nurdles from all beaches examined. Vibrio spp. occur naturally in seawater, and researchers have speculated that fecally-contaminated water was likely the original source of E. coli.

Plastisphere is a breeding ground for pathogens

A subsequent study conducted in 2020 analyzed biofilms found on plastic substrates in estuarine tributaries of Lower Chesapeake Bay (7). Vibrio spp. – specifically V. cholerae, V. parahaemolyticus, and V. vulnificus – were identified… all three of which can be pathogenic to humans. Concerningly, the authors noted that “the concentration of putative Vibrio spp. on microplastics was much greater than in corresponding water samples.” They also found a high rate of antibiotic resistance amongst isolates, noting that “the potential for plastic in aqueous environments to serve as a vector for pathogenic organisms is compounded by the possibility for its dissemination of antibiotic-resistance genes.”

Several additional studies have confirmed the presence of Vibrio spp. on marine plastics found in various bodies of water across the world – and it is only a matter of time before additional pathogens will be identified as common residents of the plastisphere. 

Plastics and the Immune System

In addition to polluting our oceans, plastics are polluting our bodies. A team examined 47 liver- and adipose-tissue specimens from donated cadavers, and detected plastic micro-and nanoparticles in 100% of samples (8). Microplastics have been found in human placentas (9), and animal models indicate that nanoplastics can cross the blood-brain barrier (10). There is also evidence that when plastics accumulate in the body, they may be harmful to the immune system. 

Recent work has examined how immune cells behave in the presence of microplastics. Microplastics coated in blood plasma were placed in culture dishes containing immune cells. Within 24 hours, 60% of immune cells were destroyed. Under the same culture conditions, but in the absence of microplastics, only 20% of immune cells were destroyed (11).

Microplastics may also alter the immune system at the level of gene expression. When adult zebrafish were exposed to microplastics, alterations in the expression of 41 genes encoding proteins attributed to immune processes were observed (12).

The toxic effects of plastic do not appear to be limited to the immune system. In animal models, plastics are found to be potentially harmful to just about every cell type and organ system. Micro- and nanoplastics appear to be pro-inflammatory (13), are known to irritate the respiratory tract (14), can act as endocrine disrupters (15), may be neurotoxic (16), and appear to alter the gut microbiome (17). Such effects are observed even in the absence of controversial additives such as bisphenol A (BPA) and phthalates.

Ocean microplastics pollution cycle

So What Can We Do?

Unfortunately, plastics are now ubiquitous. They are used in packaging materials, construction, textile manufacturing, automobiles, furniture, electronics, toys, medical devices, makeup, and even chewing gum. As a result, micro and nanoplasitics have contaminated our food chain and have been detected in cows’ milk (18), seafood (19), fruit and vegetables (20), honey and sugar (21), table salt (22), and tap water (23).

In 1960, an estimated half a million metric tons of plastic were produced each year, increasing to 348 million tons in 2017 (24). This compounding problem warrants immediate attention.

Some have suggested the use of fungi, bacteria, or worms to help dissolve plastic. Although the introduction of such organisms into the ecosystem is itself risky, solutions of this type may still be worth exploring.

Many investigators have been directing their efforts at designing biodegradable and compostable plastics and plastic alternatives. The assumption is that such materials would be less harmful to the environment and human health than traditional plastics – but there are many unknowns. One study concluded that the chemical processing required to create some existing bioplastics resulted in a greater amount of pollutants than the chemical processing used to create traditional plastics (25). Beyond this, there is no data on the interaction of biodegradable plastics with the human body.

Small everyday decisions count

While the “big-picture” solution remains elusive, there are easy steps that we can take to reduce our individual plastic footprints and lessen the potential for harm to our own bodies. We can avoid drinking and eating from plastic containers, abstain from using plastic bags, switch to wire hangers, wooden toys, etc. 

We only get one Earth, and we only get one body… and we must take great care of both. 

The GIDEON Difference

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

References

(1) G. Grass, C. Rensing, and M. Solioz, “Metallic Copper as an Antimicrobial Surface”, Applied and Environmental Microbiology, vol. 77, no. 5, pp. 1541-1547, 2010. Available: 10.1128/aem.02766-10 

(2) B. Bean, B. Moore, B. Sterner, L. Peterson, D. Gerding, and H. Balfour, “Survival of Influenza Viruses on Environmental Surfaces”, Journal of Infectious Diseases, vol. 146, no. 1, pp. 47-51, 1982. Available: 10.1093/infdis/146.1.47

(3) D. Corpet, “Why does SARS-CoV-2 survive longer on plastic than on paper?”, Medical Hypotheses, vol. 146, p. 110429, 2021. Available: 10.1016/j.mehy.2020.110429

(4) C. Coughenour, V. Stevens, and L. Stetzenbach, “An Evaluation of Methicillin-Resistant Staphylococcus aureus Survival on Five Environmental Surfaces”, Microbial Drug Resistance, vol. 17, no. 3, pp. 457-461, 2011. Available: 10.1089/mdr.2011.0007 

(5)E. Zettler, T. Mincer, and L. Amaral-Zettler, “Life in the “Plastisphere”: Microbial Communities on Plastic Marine Debris”, Environmental Science & Technology, vol. 47, no. 13, pp. 7137-7146, 2013. Available: 10.1021/es401288x

(6) A. Rodrigues, D. Oliver, A. McCarron, and R. Quilliam, “Colonisation of plastic pellets (nurdles) by E. coli at public bathing beaches”, Marine Pollution Bulletin, vol. 139, pp. 376-380, 2019. Available: 10.1016/j.marpolbul.2019.01.011

(7) A. Laverty, S. Primpke, C. Lorenz, G. Gerdts, and F. Dobbs, “Bacterial biofilms colonizing plastics in estuarine waters, with an emphasis on Vibrio spp. and their antibacterial resistance”, PLOS ONE, vol. 15, no. 8, p. e0237704, 2020. Available: 10.1371/journal.pone.0237704

(8) “Methods for microplastics, nanoplastics and plastic monomer detection and reporting in human tissues – American Chemical Society“, American Chemical Society, 2021. [Online]

(9) A. Ragusa et al., “Plasticenta: First evidence of microplastics in human placenta”, Environment International, vol. 146, p. 106274, 2021. Available: 10.1016/j.envint.2020.106274

(10) M. Prüst, J. Meijer and R. Westerink, “The plastic brain: neurotoxicity of micro-and nanoplastics”, Particle and Fibre Toxicology, vol. 17, no. 1, 2020. Available: 10.1186/s12989-020-00358-y

(11) “Nienke Vrisekoop on microplastic’s impact on human immune cells | Plastic Health Summit 2019 – YouTube“

(12) G. Limonta et al., “Microplastics induce transcriptional changes, immune response and behavioral alterations in adult zebrafish”, Scientific Reports, vol. 9, no. 1, 2019. Available: 10.1038/s41598-019-52292-5

(13) R. Lehner, C. Weder, A. Petri-Fink and B. Rothen-Rutishauser, “Emergence of Nanoplastic in the Environment and Possible Impact on Human Health”, Environmental Science & Technology, vol. 53, no. 4, pp. 1748-1765, 2019. Available: 10.1021/acs.est.8b05512

(14) A. Banerjee and W. Shelver, “Micro- and nanoplastic induced cellular toxicity in mammals: A review”, Science of The Total Environment, vol. 755, p. 142518, 2021. Available: 10.1016/j.scitotenv.2020.142518 

(15) F. Amereh, M. Babaei, A. Eslami, S. Fazelipour and M. Rafiee, “The emerging risk of exposure to nano(micro)plastics on endocrine disturbance and reproductive toxicity: From a hypothetical scenario to a global public health challenge”, Environmental Pollution, vol. 261, p. 114158, 2020. Available: 10.1016/j.envpol.2020.114158 

(16) M. Prüst, J. Meijer and R. Westerink, “The plastic brain: neurotoxicity of micro-and nanoplastics”, Particle and Fibre Toxicology, vol. 17, no. 1, 2020. Available: 10.1186/s12989-020-00358-y

(17) N. Hirt and M. Body-Malapel, “Immunotoxicity and intestinal effects of nano- and microplastics: a review of the literature”, Particle and Fibre Toxicology, vol. 17, no. 1, 2020. Available: 10.1186/s12989-020-00387-7

(18) G. Kutralam-Muniasamy, F. Pérez-Guevara, I. Elizalde-Martínez and V. Shruti, “Branded milks – Are they immune from microplastics contamination?”, Science of The Total Environment, vol. 714, p. 136823, 2020. Available: 10.1016/j.scitotenv.2020.136823

(19) M. Smith, D. Love, C. Rochman and R. Neff, “Microplastics in Seafood and the Implications for Human Health”, Current Environmental Health Reports, vol. 5, no. 3, pp. 375-386, 2018. Available: 10.1007/s40572-018-0206-z

(20) D. Yang, H. Shi, L. Li, J. Li, K. Jabeen and P. Kolandhasamy, “Microplastic Pollution in Table Salts from China”, Environmental Science & Technology, vol. 49, no. 22, pp. 13622-13627, 2015. Available: 10.1021/acs.est.5b03163 

(21) G. Liebezeit and E. Liebezeit, “Non-pollen particulates in honey and sugar”, Food Additives & Contaminants: Part A, vol. 30, no. 12, pp. 2136-2140, 2013. Available: 10.1080/19440049.2013.843025 

(22) D. Yang, H. Shi, L. Li, J. Li, K. Jabeen and P. Kolandhasamy, “Microplastic Pollution in Table Salts from China”, Environmental Science & Technology, vol. 49, no. 22, pp. 13622-13627, 2015. Available: 10.1021/acs.est.5b03163 

(23) H. Tong, Q. Jiang, X. Hu, and X. Zhong, “Occurrence and identification of microplastics in tap water from China”, Chemosphere, vol. 252, p. 126493, 2020. Available: 10.1016/j.chemosphere.2020.126493 

(24) P. Wu et al., “Environmental occurrences, fate, and impacts of microplastics”, Ecotoxicology and Environmental Safety, vol. 184, p. 109612, 2019. Available: 10.1016/j.ecoenv.2019.109612 

(25) M. Tabone, J. Cregg, E. Beckman, and A. Landis, “Sustainability Metrics: Life Cycle Assessment and Green Design in Polymers”, Environmental Science & Technology, vol. 44, no. 21, pp. 8264-8269, 2010. Available: 10.1021/es101640n

The post What Do Plastics Have to Do with the Immune System? appeared first on GIDEON.

On April 14, 2021, we recognize the second annual World Chagas Disease Day (2). Chagas disease, also known as American Trypanosomiasis, is endemic to Latin America. It can lead to severe cardiac, neurologic, and gastrointestinal disease  – and in some cases, is fatal, causing about 12,000 deaths yearly (3).

The disease represents the third-largest tropical disease burden worldwide, after malaria and schistosomiasis (4). It has likely been with us for thousands of years, as T. cruzi DNA has been recovered from ancient mummies and bone fragments (1).

Transmission of Chagas Disease

Triatomine bugs, also known as “kissing bugs,” “cone-nosed bugs,” or “bloodsuckers,” are the vectors for the disease. They acquire T. cruzi after biting infected animals or humans and transmit the parasite to others through their feces. Over 150 species of domestic and wild animals serve as reservoirs for the disease (5), including dogs, cats, pigs, rabbits, raccoons, rats, bats, armadillos, and monkeys.

Triatomine bugs are commonly found in rural areas, in houses made from mud, adobe, straw, and palm thatch (6). They feed at night. If they defecate on an individual and T. cruzi gains access to the body via a mucus membrane or break in the skin, the disease may be transmitted.

Vertical transmission of it is possible during pregnancy. Chagas disease transmission can also occur via blood transfusion and organ transplantation. There is some evidence that it may be transmitted through sex and, in rare instances, through the consumption of game meat. It can also be acquired by consuming food or water contaminated with insect remains (4).

Clinical Presentation

The incubation period for the disease depends upon the mode of transmission. Vectorially transmitted cases usually manifest in one-to-two weeks, while orally transmitted cases may take up to 3 weeks – and transfusion-based cases up to 120 days (5).

The disease has an acute and chronic phase. The acute Chagas disease phase is often asymptomatic or mild and usually resolves spontaneously (5). The acute phase may begin with developing a “chagoma” – an indurated area of erythema and swelling with local lymph node involvement (7). “Romana’s sign” consists of painless edema of the eyelids and periocular tissues (resulting from conjunctival inoculation) and is usually unilateral. Patients in the acute phase may develop fever, malaise, and anorexia. Generalized lymphadenopathy and mild hepatosplenomegaly may be present. Rarely, meningoencephalitis or severe myocarditis with arrhythmias and heart failure may occur.

10% to 30% of acute infections will progress to chronic disease. Chronic disease may present years or decades after the initial infection. Cardiac manifestations include arrhythmias, thromboembolism, and cardiomyopathy. Arrhythmias may present as episodes of vertigo, syncope, or seizures. Congestive heart failure may develop, leading to death. The cerebral disease is also characterized by headaches, seizures, focal neurological deficits, and evidence of ischemia and infarct. Gastrointestinal manifestations include megaesophagus and megacolon. Dysfunction of the urinary bladder is also reported. The disease has an overall case-fatality rate of 10% (7).

Patients with chronic Chagas disease who become immunosuppressed may experience a reactivation of the infection. In individuals with concurrent HIV/AIDS and the disease, the central nervous system is the most commonly affected site, and space-occupying lesions often occur. (8).

Diagnosis and Treatment: The Science of Blood

Chagas disease diagnosis may be done by visualizing protozoa in blood or tissue, serology, xenodiagnosis, or PCR. The anti-parasitic medications Nifurtimox or Benznidazole can be used for treatment. Treatment is curative in approximately 50-80% of acute-phase cases and 20-60% of chronic phase cases (9). Treatment is curative in greater than 90% of congenital cases when given within the first year of life (10). Treatment of pregnant women is not recommended (11).

Prevalence 

Vector-borne transmission of Chagas disease only occurs in the Americas. Approximately 121 million individuals are at risk in Central and South America and Mexico. If you have a GIDEON account, click here to explore our Chagas disease outbreak map. An estimated 8 million people are currently infected with the disease(12).  

Vector-borne disease transmission is exceedingly rare in the United States, with 28 cases documented between 1955 and 2015 (13). About 300,000 people live in the United States with the disease acquired in Latin America (14). In Europe, the prevalence of T. cruzi infection among Latin American migrants is approximately 6% (4).

In 2007, two notable outbreaks occurred due to ingesting sources contaminated with T. cruzi. 166 cases occurred in Brazil from contaminated food and 128 cases in Venezuela from contaminated juice (4). 

Prevention

Vector-control programs centered around the widespread use of insecticides have led to some success in decreasing the prevalence of the disease. This progress, however, has been recently complicated by the emergence of insecticide-resistant vectors.

Individuals living in endemic areas can decrease their risk of contracting the disease by completing home improvement projects to disrupt triatomine bug nests. These nests are commonly found beneath porches, between rocky surfaces, in wood/brush piles, in rodent burrows, and in chicken coops (15). Individuals traveling to endemic areas can decrease their risk of contracting the disease by applying insect repellent, wearing protective clothing, and using bed nets.

The screening of blood products for the disease is another important prevention strategy. In most endemic countries, all blood donations are tested for T. cruzi antibodies. Screening strategies vary in countries where cases are imported (16, 17). In the United States, all first-time blood donors are tested. In Canada, the UK, and Spain, only donors considered “at-risk” are tested (such as those who previously lived in or recently traveled to Latin America). In Sweden, individuals who lived in endemic countries for more than five years are precluded from donating blood, while in Japan, only individuals with a known history of it are excluded. In China, blood donors are not currently screened for Chagas disease.

Recently, a new surveillance system has been implemented in some countries where malaria is also endemic; microscopy technicians have been trained to identify T. cruzi in malaria films (18).