Seasonal Illness-early fall

Infectious diseases are seasonal. Flu being the most obvious example. The "flu season," the time of peak activity, is usually a 12-week period that varies from late December to March. Lately in NYC it has been in February.

In September West Nile Virus is waning as mosquitoes populations decline in the cooler weather. Emergency department asthma visits are up. These are likely due to infectious and non-infectious triggers, such as changes in the weather, particulate matter in the air and kids returning to school where they can transmit respiratory viruses to each other. Its a good time to check in with your physician, refill your meds and monitor your peak flows if you are an asthmatic.

Shades of Typhoid Mary-Part Two

The thing about Typhoid fever, the singular feature that has allowed the organism to survive the sanitary movement of the 19th century and the modern antibiotic era, is its ability to induce a carrier state. Most people infected with Typhoid fever recover, but is some, as much as 5%, continue to intermittently shed the bacteria in their stool without any symptoms. Most people have heard of Mary Mallon, aka Typhoid Mary. She was cook for wealthy NYC families in the early 20th century and is perhaps the best know Typhoid carrier. The risk carriers pose is mostly from preparing food, though being a healthcare worker is another risky occupation for a carrier.

Leela sent the microbiology samples to the lab for DNA analysis. Pulse Field Gel Electrophoresis (PFGE) is a method used to determine if two or more strains share common genetic fragments suggesting a common origin. Not quite fingerprints, but close. The PFGE patterns of the seven patients was the same. Leela tallied the answers to the questionnaires finding a latin food restaurant in common for all but one case. We next headed out to the community to pay a visit to the restaurant.

Portion Control for Obesity Control

Americans don’t like limits. Manifest Destiny. No limit Texas hold ‘em. Supersize me. Most US states are several times larger than European countries. The all-you-can-eat buffet is an uniquely American event. My favorite bagel shop serves bagels that can be used as spare tires with slabs of cream cheese the size of cinder blocks. Never is this predilection to excess more apparent than on our plates and our waists. During your next meal, take a good look. How much of your plate can you see?

The removal of trans fats, calorie counts and a tax on sugary drinks are all directed towards getting people to eat healthier and reduce caloric intake, but we are nibbling at the edges. All well and good but the bottom line is that we eat too much. And this isn’t good. We could blame our grand and great grand parents, who having survived famine, strived to ensure that their offspring never had to face such hardship. We should thank them and pass on seconds. Is the problem kids playing video games? When I was a kid we played monopoly, it didn’t make us fat. We need to have smaller portions at home and at restaurants. The responsibility for obesity is on us, literally and figuratively.

So how do you eat less food? Don’t be fooled by that lingering sensation of hunger even though you’ve just polished off a bowl of pasta. Drink some water. Let the food land before you reach for another bite. By waiting five or ten minutes you’ll realize that hunger has left the table, and you should too.

Raccoon common sense

Wild animals, whether on the Serengeti Plain or Central Park should not be approached by humans. They may look cute or hungry or hurt, but the common feature is that they are wild. To them, YOU are the biggest threat in their environment. Don’t expect they are going to applaud when you approach. Just last week there was a story of a woman in Wisconsin who tried to feed a bear in a zoo. The bear ate what she offered, plus three fingers. It took the woman’s escort to beat off the bear before he took any more of her. Leave wild animals alone. Closer to home a woman recently came to the aid of a sick raccoon. Though she wasn’t bitten, the raccoon turned out to have rabies and she is going to need the five-dose vaccine series (the rabies vaccine is given in the arm not the stomach).

Unless you’ve been living under a rock in Central Park, we’ll, even if you’ve been living under a rock in Central Park, you should know that there is an epizootic of raccoon rabies there. An epizootic is an epidemic in animals and there have been over fifty rabid raccoons found in Central Park in the last five months. What should you do? If you see a raccoon, leave it alone. If it looks sick, notify a park employee or police officer. Do not approach it. If you own a dog, make sure he or she has had a recent rabies vaccine. It is also a good idea to keep your dog on a leash.

There is no reason to panic. It is extremely rare for a rabid raccoon to attack a human. The virus infects the raccoon’s nervous system and although they can be aggressive they are sick. Nevertheless, STAY AWAY from raccoons!

For more information go to the Health Department's website

http://www.nyc.gov/html/doh/html/pr2010/pr007-10.shtml

The usual suspects

It is not unusual for us to be asked, "What is going around?" It is often followed by a description of a respiratory or gastrointestinal malady that has afflicted a friend, neighbor or relative, maybe even the caller themselves. It should come as no surprise that many infectious diseases are seasonal. Flu is probably the best example, we are all accustomed to see and hear reminders that winter is the flu season.

Well, it turns out that due to the historic appearance of pandemic H1N1 in the spring of 2009 and then again in the fall, we have very little flu circulating now. H1N1 has succeeded in vanquishing its competition, the previous dominate strains were H3N2 and a run-of-the-mill H1N1. Where the pandemic H1N1 strain has gone is a question we epidemiologists wish we could answer, maybe soon. So, what is circulating causing upper respiratory illness in NYC? If you need to put a name to your discomfort, the suspects are called rhinovirus, metapneumovirus, adenovirus and respiratory syncytial virus (RSV). Variations on the common cold. In NYC adults, it has been mostly rhinovirus of late, in young kids likely RSV.

There are two known seasonal causes of viral gastroenteritis, norovirus and rotavirus. Norovirus season usually begins in November and peaks around now. It characteristically causes vomiting along with diarrhea. The vomitus is quite infectious and when aerosolized may infect people sharing space with the ill person. It is a good idea to wash your hands and face if you witness someone vomit. The illness usually takes 1-2 days to appear after exposure and in most people does not last more than a few days.

Rotavirus is a major pathogen in the developing world and is most dangerous to the very young who can quickly dehydrate from the watery diarrhea it causes. The season traditionally begins in the spring. There is a vaccine for rotavirus, recommended to be given in infancy.

Shades of Typhoid Mary- Part One

Part One

It was Indian summer nearly a decade ago. My first since returning to home after a seven year hiatus. Leela, our first ever foodborne disease epidemiologist, who we stole from CDC, came to my cramped cubicle. She looked troubled. It was a cluster of typhoid fever, the scourge of the 18th and 19th centuries. Typhoid fever is caused by the bacterium Salmonella Typhi and it only occurred in travelers to a country where the disease was endemic (meaning regularly occurs and never really goes away). I tried to reassure her, after all it was September and the disease took about a month to show up after an exposure. Perfect timing for those summer vacations back home many foreign born residents routinely made. Leela was no greenhorn. She had worked at the Foodborne Division at CDC and was an experienced and efficient epidemiologist. She already new that none of the seven cases had traveled. It wasn't unusual for an individual to try and hide their travel, whether for reasons of citizenship or otherwise, but for seven people to all claim no travel, that was unusual.

Part two

The thing about Typhoid fever, the singular feature that has allowed the organism to survive the sanitary movement of the 19th century and the modern antibiotic era, is its ability to induce a carrier state. Most people infected with Typhoid fever recover, but is some, as much as 5%, continue to intermittently shed the bacteria in their stool without any symptoms. Most people have heard of Mary Mallon, aka Typhoid Mary. She was cook for wealthy NYC families in the early 20th century and is perhaps the best know Typhoid carrier. The risk carriers pose is mostly from preparing food, though being a healthcare worker is another risky occupation for a carrier.

Leela sent the microbiology samples to the lab for DNA analysis. Pulse Field Gel Electrophoresis (PFGE) is a method used to determine if two or more strains share common genetic fragments suggesting a common origin. Not quite fingerprints, but close. The PFGE patterns of the seven patients was the same. Leela tallied the answers to the questionnaires finding a latin food restaurant in common for all but one case. We next headed out to Queens to pay a visit to the restaurant.