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  #461  
Old 03-08-2019, 02:22 PM
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Mary Pat Campbell
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TETANUS

from the CDC
https://www.cdc.gov/mmwr/volumes/68/...6p29Eb53jE9yw4

Quote:
Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017

Spoiler:
Judith A. Guzman-Cottrill, DO1; Christina Lancioni, MD1; Carl Eriksson, MD1; Yoon-Jae Cho, MD1; Juventila Liko, MD2 (View author affiliations)

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Tetanus is an acute neuromuscular disease caused by the bacterium Clostridium tetani. Bacterial spores found in soil can enter the body through skin disruption, with subsequent onset of clinical illness ranging from 3 to 21 days (usually within 8 days). In 2017, a boy aged 6 years who had received no immunizations sustained a forehead laceration while playing outdoors on a farm; the wound was cleaned and sutured at home. Six days later, he had episodes of crying, jaw clenching, and involuntary upper extremity muscle spasms, followed by arching of the neck and back (opisthotonus) and generalized spasticity. Later that day, at the onset of breathing difficulty, the parents contacted emergency medical services, who air-transported him directly to a tertiary pediatric medical center. The boy subsequently received a diagnosis of tetanus and required approximately 8 weeks of inpatient care, followed by rehabilitation care, before he was able to resume normal activities.

Upon hospital arrival, the child had jaw muscle spasms (trismus). He was alert and requested water but was unable to open his mouth; respiratory distress caused by diaphragmatic and laryngeal spasm necessitated sedation, endotracheal intubation, and mechanical ventilation. Tetanus immune globulin (3,000 units) and diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) were administered for presumed tetanus. He was admitted to the pediatric intensive care unit and cared for in a darkened room with ear plugs and minimal stimulation (stimulation increased the intensity of his spasms). Intravenous metronidazole was initiated, and the scalp laceration was irrigated and debrided.

His opisthotonus worsened, and he developed autonomic instability (hypertension, tachycardia, and body temperatures of 97.0F–104.9F [36.1C–40.5C]). He was treated with multiple continuous intravenous medication infusions to control his pain and blood pressure, and with neuromuscular blockade to manage his muscle spasms. A tracheostomy was placed on hospital day 5 for prolonged ventilator support. Starting on hospital day 35, the patient tolerated a 5-day wean from neuromuscular blockade. On day 44, his ventilator support was discontinued, and he tolerated sips of clear liquids. On day 47, he was transferred to the intermediate care unit. Three days later, he walked 20 feet with assistance. On day 54, his tracheostomy was removed, and 3 days later, he was transferred to a rehabilitation center for 17 days.

The boy required 57 days of inpatient acute care, including 47 days in the intensive care unit. The inpatient charges totaled $811,929 (excluding air transportation, inpatient rehabilitation, and ambulatory follow-up costs). One month after inpatient rehabilitation, he returned to all normal activities, including running and bicycling. Despite extensive review of the risks and benefits of tetanus vaccination by physicians, the family declined the second dose of DTaP and any other recommended immunizations.

This is the first pediatric tetanus case in >30 years in Oregon (unpublished data, Oregon Health Authority, 2018). The diagnosis of tetanus is made based on clinical findings because the bacterium C. tetani is difficult to grow from wounds. A wound culture from the child’s laceration did not grow C. tetani. However, a negative wound culture does not rule out disease. The health care costs to treat this child’s preventable disease were approximately 72 times the mean (2012) cost of $11,143 for a U.S. pediatric hospitalization (1). A recent report describing adult tetanus cases included hospital charges ranging from $22,229 to $1,024,672 (2).

Widespread use of tetanus toxoid–containing vaccines (tetanus toxoid inactivated vaccine or a combination vaccine that contains tetanus toxoid) and tetanus immune globulin for wound management has led to a 95% decline in the number of tetanus cases and a 99% decrease in the number of tetanus-related deaths since the 1940s (3). From 2009 to 2015, 197 tetanus cases and 16 tetanus-associated deaths were reported in the United States (4). Unvaccinated or inadequately vaccinated persons are at risk for tetanus, irrespective of age, and recovery from tetanus disease does not confer immunity (5).

Routine administration of a 5-dose DTaP series is recommended for all eligible children at 2, 4, and 6 months of age, then a dose at 15–18 months of age, and a fifth dose at 4–6 years of age. Booster doses of diphtheria and tetanus toxoids are recommended every 10 years throughout life (4). Uninsured or underinsured eligible children may receive vaccines at no cost through the Vaccine For Children program (https://www.cdc.gov/vaccines/programs/vfc/index.html). Resources to assist health care providers in discussing vaccination with their patients, including how to address questions, are available online (https://www.cdc.gov/vaccines/partner...essionals.html).


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  #462  
Old 03-08-2019, 02:23 PM
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I will highlight this bit:

Quote:
One month after inpatient rehabilitation, he returned to all normal activities, including running and bicycling. Despite extensive review of the risks and benefits of tetanus vaccination by physicians, the family declined the second dose of DTaP and any other recommended immunizations.
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  #463  
Old 03-09-2019, 04:57 PM
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TYPHUS
(and more)
CALIFORNIA

https://www.theatlantic.com/health/a...IvA3437Mnyy9q8

Quote:
Medieval Diseases Are Infecting California’s Homeless
Typhus, tuberculosis, and other illnesses are spreading quickly through camps and shelters.
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  #464  
Old 03-09-2019, 05:00 PM
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to be fair, many of these "medieval" diseases were extremely common in the U.S. in the 19th century and early 20th century
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  #465  
Old 03-11-2019, 10:52 AM
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Quote:
Originally Posted by campbell View Post
to be fair, many of these "medieval" diseases were extremely common in the U.S. in the 19th century and early 20th century
Yeah, I'm watching the Masterpiece series "Victoria" and of course that's how Prince Albert died in 1861... not exactly "medieval".

(Well, his official cause of death was typhus although there's been subsequent speculation that his constant stomach pain may have indicated Crohn's disease or kidney failure.)
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  #466  
Old 03-11-2019, 11:44 AM
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Quote:
Originally Posted by campbell View Post
...They did a blood test on D, though, and said he still had the antibodies.
Hey, thanks for this. I discussed measles with my doctor and I'm going to get my titer tested. My guess is it will be fine, but if it's not, I'll discuss whether it's worth the risk to get a booster shot.

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I will highlight this bit:


That seems really crazy.
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  #467  
Old 03-11-2019, 01:30 PM
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JFC, Typhus? What are the current odds on an outbreak of dysentery and Cholera? Smallpox?

TBF, Tuberculosis never completely stopped being a problem, just less frequent.
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  #468  
Old 03-13-2019, 10:25 AM
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MEASLES
LOS ANGELES, CALIFORNIA

https://laist.com/2019/03/12/lax_air...er_measles.php

Quote:
LAX Passenger Who Traveled With Measles Raises Concerns Of Possible Outbreak

Spoiler:
Los Angeles County health officials are alerting travelers about a possible measles exposure that happened at LAX late last month, the latest alarming development for a disease once thought to be eliminated in the U.S.

The infected passenger traveled through the airport's Terminal B, which handles international flights, and Delta Airlines' terminal, Terminal 3, between 9 a.m. and 9 p.m. on Feb. 21, according to L.A. County's Department of Public Health.

Terminal B has 29 gates and hosts a number of international airlines including Air France, China Airlines, Lufthansa, and Korean Air. Terminal 3 has 12 gates and home to Delta Airlines and smaller airlines like Interjet and Copa.

According to the flight numbers released by health officials, the person infected with measles, first landed at LAX's Terminal B in the morning of Feb. 21 on a China Eastern flight from Shanghai. He or she then went on to Terminal 3, Gate 32 to wait for a Delta flight to San Antonio, Texas.

L.A. County officials said they first learned about the case of the highly contagious virus on March 7.


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  #469  
Old 03-15-2019, 04:57 PM
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COLORADO
PLAGUE

https://amp.livescience.com/64980-do...-colorado.html

Quote:
Pet Dog with Plague Exposed More Than 100 Veterinary Workers to the Disease
Spoiler:
A sick dog in Colorado caused alarm at a veterinary hospital when doctors realized the animal was infected with a rare and deadly illness: the plague. What's more, the dog had contact with more than 100 people before its illness was discovered, potentially exposing them to the serious infection, according to a new report about the case.

The 3-year-old dog developed a fever and was acting lethargic in December 2017, prompting its owner to take the animal to the vet, where it was treated with antibiotics. But soon thereafter, the dog began coughing up blood and was referred to the Colorado State University Veterinary Teaching Hospital.

Tests revealed that the dog had a lung infection. Four days before the dog became sick, it was seen sniffing a dead prairie dog — an animal that can carry the plague-causing bacteria Yersinia pestis. But the vets considered an infection with plague to be unlikely, in part because of the time of year; plague infections mainly occur from April to October in the Western U.S., according to the report. And since dogs are less susceptible to plague than cats are, the chance that the animal was infected would seem even more remote. [11 Ways Your Beloved Pet May Make You Sick]

Instead, the vets suspected a much more common cause for the dog's illness: so-called aspiration pneumonia, a lung infection due to an inhaled foreign body, such as food. Indeed, results from a CT scan appeared to match this diagnosis, the report said.

Two days later, however, a sample from the dog's lungs tested positive for plague-like bacteria. But the vets still weren't convinced: Because a plague infection was considered so unlikely, they at first thought the test result might be wrong.

The next day, the researchers used a standard testing protocol for plague from the Centers for Disease Control and Prevention (CDC), which also came back positive. What's more, the dog had pneumonic plague, the most serious form of the disease, which can be spread through the air in infected droplets expelled by an sick animal or person.

Possible exposure
Even before the dog's diagnosis was confirmed, news of the suspected plague case spread through the veterinary hospital and staff became nervous about possible exposure to the disease.

Indeed, during the dog's care, the animal had been transported throughout the hospital and even housed in an oxygen cage that vented into a room. Overall, 116 people were identified as possibly being exposed to the plague through contact with the dog or its samples, or by being within 6 feet away (where they could potentially inhale infectious droplets.)

Plague is perhaps best known for killing millions of people in Europe in the 1300s during a pandemic called the Black Death. But the infection still occurs today, although it is relatively rare in the United States, with an average of seven human plague cases reported yearly – particularly in New Mexico, Arizona and Colorado – according to the CDC. Most U.S. human cases of plague occur in the Southwest.

Among employees at the hospital who were potentially exposed to the disease, about 60 percent took preventative antibiotics. In addition, 46 animals that were housed in the same room as the dog were also considered exposed and were also given preventative antibiotics. Fortunately, there were no reported cases of plague in either humans or animals in connection with the case.

Unfortunately, the dog's condition worsened and it had to be euthanized on the same day it was diagnosed.

Veterinarians should be aware that cases of plague can show up in dogs year round, not just in the more common months of late spring to early fall, the report said.

In 2014, a dog in Colorado contracted pneumonic plague, which lead to an outbreak of the disease in four people — the largest outbreak of the illness since the 1920s, according to the CDC. In that case, a dog spread the illness to three people (including its owner), and a fourth person contracted the disease from the owner, Live Science previously reported.

The case was published online today (March 13) in journal Emerging Infectious Diseases.


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  #470  
Old 03-15-2019, 05:44 PM
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Fortunately, plague is susceptible to antibiotics, if caught early enough. Which is probably why that article based on a case in 2017 doesn't mention anyone dying due to exposure to the dog.
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