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  #371  
Old 04-12-2018, 04:21 PM
Westley Westley is offline
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Originally Posted by campbell View Post
There's also a powerpoint deck here:
https://www.cdc.gov/flu/weekly/weekl.../FluView03.ppt

(The template is awful..you have to see it for yourself)
Wowzers. Just looked at this. Template... did not disappoint.
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  #372  
Old 04-12-2018, 04:45 PM
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Yes. It is exemplary of governmental powerpoint templates.



But as flu season winds down, thought I'd update the pediatric flu death count:

https://www.cdc.gov/flu/weekly/index.htm#S3

It's at 142 right now, just a little lower than the 148 of 2014-2015. That said, there will probably be a few more cases, so it looks like the 2017-2018 season will be coming in higher.

The history here:
https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html

The 2009-2010 season was worse with 288 pediatric deaths - that was the H1N1 (swine flu) mutation when the incidence/mortality was pretty bad worldwide, but nowhere near spanish flu pandemic levels

https://www.cdc.gov/flu/pastseasons/0910season.htm
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  #373  
Old 04-18-2018, 05:20 PM
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TYPHOID

PAKISTAN

https://arstechnica.com/science/2018...ding-globally/

Quote:
First XDR typhoid is on the verge of being untreatable, spreading globally
Health experts say outbreak is a "clarion call" for health authorities worldwide.

Spoiler:
A tenacious epidemic of extensively drug-resistant (XDR) typhoid in Pakistan is just one small genetic step away from becoming untreatable—and health experts expect it to spread worldwide.

“It’s a global concern at this point,” Dr. Eric Mintz, an epidemiologist at the Centers for Disease Control and Prevention told The New York Times. “Everything suggests this strain will survive well and spread easily—and acquiring resistance to azithromycin is only a matter of time.” Azithromycin is currently the only antibiotic remaining that treats the infection.

Typhoid fever, caused by Salmonella enterica serovar Typhi bacteria, is endemic to Pakistan, parts of which suffer from poor infrastructure, crowded urban areas, and insufficient access to healthcare. The epidemic caused by the XDR strain—the first of its kind—has been unfolding there since November 2016. It has now affected at least 850 people in 14 districts, according to the latest figures from the National Institute of Health in Islamabad and first reported by the Times. Prior to this epidemic, there were only four known, unrelated cases of such heavily drug-resistant typhoid, occurring in Iraq, Bangladesh, India, and Pakistan.

The XDR strain has already begun spreading outside of Pakistan, with a travel-related case appearing in the United Kingdom.

In a recent report on the strain’s emergence in the journal mBio, infectious disease experts established that it could withstand assaults from five classes of antibiotics used to treat typhoid. They concluded that the strain’s development was a “startling demonstration” of how easily S. Typhi can pick up genetic elements that confer drug resistance, “rendering it XDR and further narrowing treatment options.”

Antibiotics are the only effective treatment for typhoid fever, a systemic infection with varying severity that can become life-threatening. The infection is generally marked by fever, headache, nausea, loss of appetite, and constipation or sometimes diarrhea. The heaviest death tolls are in children younger than age four. About 2 to 5 percent of those infected can become chronic asymptomatic carriers, shedding the bacteria in their feces. The Salmonella Typhi bacteria are typically spread through food or water contaminated with feces.

Stinky squall
Researchers estimate that there are somewhere between 10 million to 20 million cases each year worldwide, leading to between 130,000 to 210,000 deaths. And that’s the case with antibiotic treatments largely still available and working.

“Most clinicians and clinical microbiologists today do not appreciate the lethality that typhoid fever exhibited in the pre-antibiotic era,” Myron Levine and Raphael Simon say. The vaccine researchers, both from University of Maryland School of Medicine, wrote a commentary recently on the “gathering storm” of XDR typhoid in Pakistan.

In the epidemic, researchers suspect leaking sewage lines were to blame for the creation and spread of the XDR strain. According to the Times, early disease mapping showed cases clustering around sewage lines in the city of Hyderabad. Researchers speculate that, within that seeping sewage, the aggressive MDR typhoid strain H58 encountered and picked up a circular piece of DNA (a plasmid) containing genes encoding additional drug resistance, likely from an E. coli strain or other enteric bacteria. This refuse rendezvous created the XDR strain.

With the epidemic well underway, health authorities have already begun a campaign to step up sanitation and hygiene efforts, such as making sure people boil drinking water and increase hand washing. Health authorities are also trying to get children vaccinated against the harmful germs.

As Levine and Simon note in their commentary, “we know how to impede amplified transmission of typhoid in most areas of endemicity, i.e., to treat water supplies and make them widely available and to improve sanitation and personal hygiene so that human feces do not contaminate water and food.” But, they note, such efforts “are expensive and require time to deploy, even if political will and financing are available.”

The recent spread of the XDR H58 is a “clarion call,” they conclude.

“Now is the time for global action to prevent a ‘gathering storm’ from becoming a ‘perfect storm’ and an enormous public health crisis.”
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Old 04-27-2018, 01:40 PM
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PANDEMIC

https://www.washingtonpost.com/news/...=.c921d163067e

Quote:
Bill Gates calls on U.S. to lead fight against a pandemic that could kill 33 million
Spoiler:
Bill Gates says the U.S. government needs to seize the opportunity to lead the nation and the world in preparing for the “significant probability of a large and lethal modern-day pandemic occurring in our lifetimes.”

In an interview this week, the billionaire philanthropist said he has raised the issue of pandemic preparedness with President Trump since the 2016 presidential election. In his most recent meeting last month, Gates said he laid out the increasing risk of a bioterrorism attack and stressed the importance of U.S. funding for advanced research on new therapeutics, including a universal flu vaccine, which would protect against all or most strains of influenza.

Gates, who co-founded Microsoft and now leads a foundation on global health, said he told Trump that the president has a chance to lead on the issue of global health security. Trump encouraged him to follow up with top officials at the Health and Human Services Department, the National Institutes of Health and the Food and Drug Administration, Gates said.

Gates said he met several times with H.R. McMaster, the president’s former national security adviser, and hopes to meet with McMaster’s replacement, John Bolton. The National Security Council, Gates said, is an appropriate office to “show leadership on this issue and decide how to coordinate the various groups” within the government.

“But, you know, I think we’ve got to push this ... with the executive branch and Congress quite a bit,” Gates said. “There hasn’t been a big effort along these lines.”

His interview with The Washington Post prefaced a speech — on the challenges associated with modern epidemics — that Gates gave Friday before the Massachusetts Medical Society.

Gates and his wife, Melinda, have repeatedly warned that a pandemic is the greatest immediate threat to humanity. Experts say the risk is high because new pathogens are constantly emerging and the world is so interconnected.

Many experts agree that the United States remains underprepared for a pandemic or a bioterrorism threat. The government’s sprawling bureaucracy, they say, is not nimble enough to deal with mutations that suddenly turn an influenza virus into a particularly virulent strain, as the 1918 influenza did in killing an estimated 50 million to 100 million people worldwide.

Even this winter’s harsh-seasonal flu was enough to overwhelm some hospitals, forcing them to pitch tents outside emergency rooms to cope with the crush of patients.

If a highly contagious and lethal airborne pathogen like the 1918 influenza were to take place today, nearly 33 million people worldwide would die in just six months, Gates noted in his prepared remarks, citing a simulation done by the Institute for Disease Modeling, a research organization in Bellevue, Wash.

In those remarks, Gates highlighted scientific and technical advances in the development of better vaccines, drugs and diagnostics that he said could revolutionize how we prepare for and treat infectious diseases moving forward. He praised last year’s formation of a new global coalition, known as CEPI, to create new vaccines for emerging infectious diseases. He also announced a $12 million Grand Challenge in partnership with the family of Google Inc. co-founder Larry Page to accelerate the development of a universal flu vaccine.

But vaccines, he noted, take time to research, deploy and generate protective immunity.

“So we need to invest in other approaches, like antiviral drugs and antibody therapies that can be stockpiled or rapidly manufactured to stop the spread of pandemic diseases or treat people who have been exposed,” he said in his speech.

Among the advances in these areas are a new influenza antiviral recently approved in Japan that Gates said “stops the virus in its tracks” by inhibiting an enzyme it needs to multiply; research on antibodies that could protect against a pandemic strain of a virus; and a diagnostic test that harnesses the powerful genetic-engineering technology known as CRISPR and has the field-use potential to check a patient’s blood, saliva or urine for evidence of multiple pathogens. That test could, for example, identify if someone is infected with Zika or dengue virus, which have similar symptoms.

But even the best tools in the world won’t be sufficient, Gates said, if the United States doesn’t have a strategy to harness and coordinate resources at home and help to lead an effective global preparedness and response system.

Trump and senior administration officials have affirmed the importance of controlling infectious disease outbreaks. But the Centers for Disease Control and Prevention is facing a loss of emergency funding provided in the wake of the 2014 Ebola epidemic and has begun to dramatically downsize its epidemic-prevention activities in 39 out of 49 countries where disease risks are greatest.

Congress provided some additional funding in last month’s spending bill. But it also directed the administration to come up with a comprehensive plan to strengthen global health security at home and abroad.

“This could be an important first step if the White House and Congress use the opportunity to articulate and embrace a leadership role for the U.S.,” Gates said in the speech.

No other country, he noted, has the depth of scientific or technical expertise that the United States possesses, drawing on the resources of institutions such as NIH, CDC and the Biomedical Advanced Research and Development Authority, as well as the Defense Department's Defense Advanced Research Projects Agency.


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  #375  
Old 04-27-2018, 05:35 PM
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SEASONAL FLU

https://www.thinkadvisor.com/2018/04...ifeHealthDaily

Quote:
Flu Shows Up in a Life Reinsurer's Earnings
RGA executives say this year's epidemic pushed up the number of life claims.
Spoiler:
How bad was this year’s flu season?

Bad enough to hurt a major life reinsurer’s earnings.
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Reinsurance Group of America Inc. is reporting $100 million in net income for the first quarter on $3.2 billion in revenue, compared with $146 million in net income on $3 billion in revenue for the first quarter of 2017.

The RGA unit that provides traditional reinsurance in the United States and Latin America, but not in Canada, is reporting $2.9 million in income before income taxes for the quarter on $1.5 billion in revenue, compared with $30 million in income before taxes on $1.5 billion in revenue for the year-earlier quarter.

RGA said the harsh flu season in the United States and Latin America contributed to the drop in overall net income, by increasing the number of non-large death claims.

Anna Manning, president of the Chesterfield, Missouri-based company, said flu often causes fluctuations in claims during the first quarter of the year.

“Any volatility tends to even out over longer periods,” Manning said.
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  #376  
Old 05-21-2018, 05:04 PM
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https://www.washingtontimes.com/news...gins-phase-2-/

Quote:
Experimental universal flu vaccine begins second phase of testing in U.S.: Report

Spoiler:
The second phase of human trials for a universal flu vaccine has begun in the U.S., the National Institutes of Health announced Friday, as scientists continue to search for an all-encompassing solution to protecting against the unpredictable and constantly mutating virus.

The clinical trial, which will take place at four sites around the U.S., will enroll 120 healthy volunteers to either be injected with the experimental vaccine, called M-001, or a placebo.

Six previous clinical trials with a total of 698 participants in Israel and Europe established that M-001 was safe, well-tolerated and produced an immune response to a broad range of influenza strains, according to a statement by the NIH.

Participants who either receive the experimental vaccine or the placebo will also be injected with the seasonal flu vaccine.

Seasonal flu vaccine effectiveness ranges from year to year because scientists must decide which virus to develop a vaccine against before the season begins. Last year’s flu season, one of the most deadly on record, was plagued by a number of challenges, including low vaccine effectiveness and high rates of a flu strain that is inherently more aggressive.

“The 2017-2018 influenza season in the United States was among the worst of the last decade and serves as a reminder of the urgent need for a more effective and broadly protective influenza vaccine,” National Institute of Allergy and Infectious Diseases Director Dr. Anthony S. Fauci, said in a statement.

Each year, seasonal influenza sickens millions in the United States and results in 140,000 to 710,000 hospitalizations and between 12,000 and 56,000 deaths, according to the federal Centers for Disease Control and Prevention.

“An effective universal influenza vaccine would lessen the public health burden of influenza, alleviate suffering and save lives. There are numerous paths of inquiry that the scientific community is pursuing, with each new study yielding more critical information and bringing us closer to our shared goal.”
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Old 06-22-2018, 05:44 AM
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KEYSTONE VIRUS
FLORIDA
MOSQUITO-BORNE

http://www.fox5ny.com/health/first-h...-north-florida
Quote:
First human case of virus spread by mosquitoes reported in Florida

Spoiler:
TAMPA (FOX 13) - It’s mosquito season and it’s almost impossible to avoid being bitten.

Concerns about mosquito-borne viruses like Zika and West Nile are renewed every year, but a mosquito-borne disease thought only to be transmitted to animals seems to have jumped the barrier to humans.

Scientists first discovered the Keystone virus in the Keystone area of Tampa 50 years ago.

The first known human case of the disease was just identified in North Florida, but it took doctors a year to make the diagnosis.

photo
Doctors say there were likely other undiagnosed cases before this one.

“There is a reasonable chance that there is a number of cases out there,” Dr. Glenn Morris, director of the University of Florida’s Emerging Pathogens Institute.

The patient is a 16-year-old boy.

After attending band camp in North Florida last summer, he went to a walk-in clinic complaining of a fever and severe rash. Morris says the teen exhibited only mild symptoms.

Doctors tested him for various pathogens, including Zika, but nothing came back positive. After a year of investigating, they finally figured out it was the Keystone virus.

They suspect a lot of other people across the southeast may have had the virus but were never diagnosed.

In mosquitos, the virus has shown up from the Chesapeake Bay to Florida and all the way to Texas.

Right now, there is no simple test to identify the Keystone virus, but that could change soon.

Dr. Morris says several biomedical companies have contacted the University of Florida to talk about developing one.


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  #378  
Old 07-15-2018, 04:56 PM
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DRUG-RESISTANT YEAST

https://www.wired.com/story/the-stra...m_medium=email

Quote:
THE STRANGE AND CURIOUS CASE OF THE DEADLY SUPERBUG YEAST

Spoiler:
A PATHOGEN THAT resists almost all of the drugs developed to treat or kill it is moving rapidly across the world, and public health experts are stymied how to stop it.

By now, that’s a familiar scenario, the central narrative in the emergence of antibiotic-resistant bacteria. But this particular pathogen isn’t a bacterium. It’s a yeast, a new variety of an organism so common that it’s used as one of the basic tools of lab science, transformed into an infection so disturbing that one lead researcher called it “more infectious than Ebola” at an international conference last week.


Maryn McKenna (@marynmck) is an Ideas contributor for WIRED, a senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University, and the author of Beating Back the Devil, Superbug, and Big Chicken. She previously wrote WIRED’s Superbug blog.

The name of the yeast is Candida auris. It’s been on the radar of epidemiologists only since 2009, but it’s grown into a potent microbial threat, found in 27 countries thus far. Science can’t yet say where it came from or how to control its spread, and hospitals are being forced back into old hygiene practices—putting patients into isolation, swabbing rooms with bleach—to try to control it.

To a medical system that’s been dealing with worsening antibiotic resistance for decades, this chronology feels somewhat familiar: just another, potentially tougher battle to face. But the struggle to keep this resistant yeast from surging is a warning sign that relying on standard responses won't work. As the foes continue to evolve, medicine needs both new tech, and surprisingly old techniques, to fight its microbial wars.

As the foes continue to evolve, medicine needs both new tech, and surprisingly old techniques

“This bug is the most difficult we’ve ever seen,” says Dr. Tom Chiller, the chief of mycotic diseases at the CDC, who made the Ebola remark at the 20th Congress of the International Society for Human and Animal Mycology in Amsterdam. “It’s much harder to kill.”

The center of the emerging problem is that this yeast isn’t behaving like a yeast. Normally, yeast hangs out in warm, damp spaces in the body, and surges out of that niche only when its local ecosystem veers out of balance. That’s what happens in vaginal yeast infections, for instance, and also in infections that bloom in the mouth and throat or bloodstream when the immune system breaks down.

But in that standard scenario, the yeast that has gone rogue only infects the person it was residing in. C. auris breaks that pattern. It has developed the ability to survive on cool external skin and cold inorganic surfaces, which allows it to linger on the hands of healthcare workers and on the doorknobs and counters and computer keys of a hospital room. With that assist, it can travel from its original host to new victims, passing from person to person in outbreaks that last for weeks or months.

Yeast is a fungus, but C. auris is behaving like a bacterium — in fact, like a bacterial superbug. It’s a cross-species shift as inexplicable as if a grass-munching cow hopped a fence and began bloodily chomping on the sheep in the pasture next door.

The accepted narrative of new diseases is that they always take us by surprise: Science recognizes it after it has begun to move, with the second patient or the tenth or the hundredth, and works its way back to find Patient Zero. But C. auris was flagged as troublesome from its first discovery, though its identifiers didn’t understand at the time what it might be able to do.

The accepted narrative of new diseases is that they always take us by surprise

The story begins in 2009, when a 70-year-old woman already in a hospital in Tokyo developed a stubborn, oozing ear infection. The infection didn’t respond when doctors administered antibiotics, which made them think the problem might be a fungus instead. A swab of her ear yielded a yeast that appeared to be a new species. Microbiologists Kazuo Satoh and Koichi Makimura named it for the Latin word for “ear.”

That story also would have ended in 2009—new species, new nomenclature, another entry in a textbook—except for an unnerving fact. Fungal infections have never been a high priority in medical research, and as a result, there are very few drugs approved for treating them—only three classes of several drugs each, compared to a dozen classes and hundreds of antibiotics for bacteria. This novel yeast was already showing some resistance to the first-choice antifungals that would have been used against it, a family of compounds called azoles that can be given by mouth.

The back-up choice, a drug called amphotericin, is IV-only, and also so toxic—its severe fever-and-chills reactions have been dubbed “shake and bake”—that doctors try to avoid it whenever possible. That left only one set of drugs available, a new IV-only class called echinocandins. C. auris entered medical awareness accompanied by the knowledge that, if it blew up into a problem, it would be difficult to treat.

Still, at that point it had only caused an ear infection. That might have been a random occurrence; there was no reason to assume worse to come. Except, at about the same time, physicians in South Korea were called on to treat two hospital patients, a 1-year-old boy with a blood-cell disorder and a 74-year-old man with throat cancer. They both had developed bloodstream infections caused by the newly discovered yeast. And in both their cases, the organism was partially resistant to the azole class and also to amphotericin. Both died.

The same novel bug, occurring in unrelated patients, in different body systems, simultaneously in two countries, made epidemiologists wonder whether there might be more to come. There was. In just a few years, C. auris infections were recognized in India, South Africa, Kenya, Brazil, Israel, Kuwait and Spain. As with the Korean and Japanese cases, there was no connection between the different countries’ patients. In fact, the strains were genetically different on different continents—suggesting that C. auris had not begun in one place and then spread by transmission, but had arisen simultaneously everywhere, for reasons no one could discern.

But the minutely different strains had the same impact on patients: They were deadly. Depending on the country and the location of their illness in their bodies, up to 60 percent of infected patients died.

The situation looked so alarming that the public health authorities of England and the European Union rushed out urgent bulletins, warning hospitals to look for the arrival of the bug. The CDC, whose main responsibility is monitoring and preventing diseases within US borders, took the unusual step of publishing a warning before the resistant yeast even arrived in this country. “We wanted to get out ahead of the curve, to try to inform our healthcare community,” Chiller told me at the time.

Now there have been 340 cases recorded in the US, in 11 states—and the behavior of the bug in this country is teaching microbiologists more about how the new yeast behaves. It seems that not every continent develops its own strain. Instead, the U.S. is playing host to several micro-epidemics, each of which was sparked by one or several travelers from somewhere else. Cases found in New York, New Jersey, Oklahoma, Connecticut, and Maryland bear the genetic pattern of South Asia. Illinois, Massachusetts, and Florida’s cases show South America’s genetic pattern. And randomly, the few cases recorded in Indiana seem to be linked to a South African strain.

Wherever they come from, the subtle variants of C. auris share an important characteristic: They are highly drug resistant. Last year, the CDC disclosed an analysis of isolates from the US and the 26 other countries where C. auris has surfaced. More than 90 percent were resistant to azoles; 30 percent were resistant to the class that contains amphotericin; and globally, up to 20 percent were resistant to the last-ditch echinocandins. In the United States, 3 percent have been.

They also pose another challenge: long-lasting hospital outbreaks. One London hospital, the Royal Brompton, began finding the resistant yeast in early 2015. To try to stop its spread, the hospital put patients into isolation; regularly swabbed any other patient who had been in the same room as the infected persons, and all of the staff who had any contact with them; required every healthcare worker, janitor, or visitor to wear gowns, gloves, and aprons; bathed the patients twice a day with disinfectant, administered disinfectant mouthwash and dental gel, and washed the rooms three times per day with diluted bleach. When the patients moved out, the rooms they had stayed in and any equipment that had been used on them were bombed with hydrogen peroxide vapor.

Despite all those precautions, the yeast caused a 50-person outbreak that lasted more than a year. It survived the disinfectant baths and found places to hide from the bleach. And it stubbornly persisted on bodies. One patient tested negative for the bug three times, and then, on a fourth screen, tested positive again.

The London hospital published a description of its battle in late 2016. Other hospitals have learned from it—but an account published by the CDC shows how much effort preventing an outbreak can take.

In April a year ago, a hospital in Oklahoma perceived that a single patient was carrying C. auris. To keep it from spreading, the hospital slammed the patient into isolation and enforced strict infection control. It also called in a CDC team, which took 73 samples from the patient, his room, other rooms where he had stayed, and other patients he might have been in contact with, and hauled them all back to Atlanta for genomic analysis. Their quick action kept the deadly yeast from spreading elsewhere in the hospital—but it represented an emergency expenditure of resources and time that no hospital could make routine.

There aren’t many bright spots in the looming battle against C. auris. One may be this: Most of the patients so far, and all of those who have died, have been people who were hospitalized because they were already somehow ill—with diabetes, cardiovascular disease, cancers, and other illnesses. They were on ventilators, threaded with IVs and catheters, and receiving multiple drugs that undermined their immune systems’ competence.

That means there’s a limited population who may be at risk, which also means there’s a limited group for whom the most costly protections should be necessary. But patients that ill are often cared for, not in hospitals, but in nursing homes and skilled nursing facilities—and those institutions tend not to hire or empower the sharp-eyed infection-prevention practitioners that hospitals do. So that raises the question of how to detect the yeast in a patient before that person enters an institution. Must every patient be interrogated for a recent history of foreign travel? Should every new arrival be checked, with skin and gut swabs and lab tests, as part of hospital admission?

Screening won’t be a perfect defense, because clinical microbiology is struggling with this bug. Multiple accounts written over the past few years reveal that most of the patients who carried C. auris—more than 80 percent in one paper—were misidentified at first, judged on laboratory assays to have other, less risky forms of yeast. Recently the CDC published a lengthy guidance for laboratories, explaining in detail the mistakes that seven separate testing methods make in identifying it, and urging labs to contact the agency whenever it is suspected or diagnosed.

It’s critical that medicine develop better tests and routine practices, and that sluggish development of new antifungal drugs be speeded up. In the absence of new tech, what seems to be helping is one of the oldest practices in medicine—but even that requires scrutiny to be sure it is done well.

Where outbreaks have been stopped, it has been due to hard efforts in hospital cleanliness: not sharing equipment between sick people; not taking rolling computers into patients’ rooms; scrubbing the walls and floors and bedrails, and checking afterward to make sure that cleaning solutions actually kill the bug. (There is some early evidence that quarternary ammonium cleansers, the most commonly used hospital disinfectants, don’t kill C. auris; but everyday chlorine bleach can.)

The most important steps may be the low-tech ones that are hardest to enforce routinely: wearing gloves, wearing gowns, washing hands. Ignaz Semmelweis, who was born 200 years ago last week, spent his life insisting that hygiene is the most essential act in medicine. The most resistant superbugs remind us that it may be the last protection that we have.


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