31 03 2011

Rabies transmission from dogs to humans has been known since ancient times. Mad dogs and their bites get a mention in the Babylonian Code of Eshnunna, dating back to 2300 BCE, when a death-dealing bite from a dog cost its owner “two thirds of a mina of silver,” or a little less than a pound of silver.

Indeed, the disease gets a mention from ancient luminaries such as Aristotle and Celsus, but it wasn’t until the 19th century that Louis Pasteur developed a way of preventing the disease in animals, taking nerve tissue from infected rabbits  and drying it out to weaken the virus for use in a vaccine. On July 6, 1885, Pasteur tried his vaccine out in a young boy who had suffered a bite from a rabid dog. The boy lived and did not develop rabies. The vaccine had been a success.

This breakthrough led to development of a vaccine for animals and a preventive vaccine for humans who had been bitten by animals suspected or confirmed to have rabies. Yet, the disease remained a fear well into the 20th century, a featured element in American literature from Old Yeller to To Kill A Mockingbird.

Even today, with widespread vaccine campaigns targeting domestic pets, rabies persists in some wild populations, such as bats, where infection rates run about 6%. Where bats occur, health officials struggle to keep the public informed, warning that no bat should ever be touched or handled because of the risk of rabies transmission. Exposure to bats can kick up during the summer months when people are outdoors more. One study found that 46% of rabies-related bites came from bats, and the huge majority of these infectious bites occur during the summer months.

Other wild animals that carry rabies include foxes, raccoons, skunks, and coyotes. And even though only 27 cases of confirmed infection have been reported in people in the United States since 1990, every year between 16,000 and 39,000 people receive treatment because of suspected exposure.

Until recently, anyone who was exposed had to undergo a series of five shots to avoid developing the disease, which is almost invariably fatal. That series can now be reduced to four.

While vaccines were once based on virus grown in nervous system tissue, today’s vaccines are instead grown in cells in culture.

It’s pretty straightforward to avoid contracting rabies, but children in particular need to be educated about the rules: avoid contact with all wild animals known to transmit the disease, including bats, foxes, coyotes, and skunks. Never touch or approach an injured animal, and if you have a domesticated pet, such as a dog or cat, be sure that Spot or Fifi is completely up to date on all vaccines.

World Rabies Day, should you wish to party down, is September 28.

Life On a Blog

24 03 2011

image by inju

Blogging is therapeutic. For those living with or affected by infectious diseases, it can be a way to connect with those whose lives mirror their own.

Brooke Davidoff, diagnosed HIV positive in January 2010, blogs about her life as a newlywed and a first-time mom. Brooke’s life turned upside down during her pregnancy, when she had a routine blood test for HIV and discovered she was positive. “If there was no baby, I’d still have no idea,” she blogged. 

Brooke started blogging “. . . to express myself, I don’t know how not to. When I was diagnosed, I searched for stuff written by other HIV positive females to relate to, and I had a very hard time finding what I was looking for. So I began to write it for other women like me who needed to know they are not alone.”

Sabina is a 15-year-old girl who loves volleyball and dancing. She’s slogging through a year of treatment for hepatitis C and blogs about it “. . .  to share my experience of HCV treatment for children or adults who are starting or already started their treatment. I know that treatment can be difficult and painful, I would just like to give another perspective. I just want to help out and be there for other kids or adults.”

Elizabeth Boskey, PhD, MPH, calls on her education and research experience each time she blogs about STDs. Ever the teacher, Elizabeth says, “There is a lot of secrecy and stigma surrounding STDs. I blog about STDs not only to address the misconceptions about them, but to make them a topic of discussion.

“Some people think that having an STD means that they’re dirty or ruined, that infection marks them as a slut or somehow undesirable—all of which is ridiculous. Still, these feelings are common in people who have had bad experiences disclosing an STD to a partner, or who have simply internalized the stigma that is widely present in American society.

“People make jokes, and not kind ones, about STD infection, but the truth is that STDs are just diseases like any other. Yes, they are often preventable, and people should do their best to prevent them, but acquiring an STD doesn’t make you a bad person.”

Are you ready to blog?
It’s easy to get started. There’s no cost, other than your time, and, if you’re speaking from personal experience, what it costs you to speak from your heart.

Brooke blogs to share with women like herself, and to let her friends and family know that she’s OK. “I think I’m helping other people feel more normal…the stigma hopefully will diminish in time.”

Blogging can be a positive experience, but there are emotional risks.

“I think that if more people blogged about STDs it might help reduce some of the stigma associated with them,” says Elizabeth. “However, I think it’s important to acknowledge that doing so is not without risks. Publicly acknowledging an STD infection may change the way that people around you treat you. It may even affect your employment—although it shouldn’t.”

It’s OK to not share every single thing in your life. Write honestly, but don’t fret about keeping some details private. It is your life, so you define the boundaries beyond which you’re not comfortable sharing.

If you write about it, they will come, but be prepared for the readers’ thoughts that may cascade upon you. Some comments you’ll treasure and some, well, let’s just say they’ll raise the eyebrows.

“I check daily for new comments and emails,” says Brooke. “The ones that touch me the most are people who found out the same way I did, or the ones who decided to have a baby after reading my story.”

There’s a yin yang to blogging, as there is elsewhere in life. Be prepared for the nasties you’ll find in the comments section of your blog.

“Although blogging can be a wonderful way to gather personal support, it may also have less positive results,” explains Elizabeth. “Comments can be negative, or even cruel and vindictive. It may be worth blogging anonymously if you are concerned about your privacy and the ramifications for exposure in your daily life; however, it is very difficult to ‘guarantee’ that your identity will not become known. This is particularly true if you are discussing sensitive issues such as those involving your sexuality.”

Last words
Bloggers always get the last word, and that’s no less true for our guests today.

Brooke on HIV: I live a normal life other than taking pills every day. I’m waiting to see what the disease does to me. I think all of us sit and wonder when it’s going to kick in, and what it’s going to do.
If you’re having unprotected sex, get tested. You never know. There are really no symptoms that would lead you to get the test, it’s better to know and get on meds now than find out when it’s too late and you’re really sick.

Sabina on HCV: [I want people to know] that we’re not harmful to others as long as we don’t share blood transferring items, such as razors, and toothbrushes. And that having HCV [hepatitis C virus] doesn’t set you apart from others even though it’s a serious virus.

Elizabeth on STDs: I don’t think you have to blog about STDs to help destigmatize them. Make a point of having open and honest discussions of sexuality with your partners and your family. Don’t allow people to get away with making cruel comments about infectious diseases or even “cute” jokes. And, finally, remember that a lot of the stigma surrounding STDs has to do with ignorance. Educate yourself—about how common STDs are, about testing, and about prevention—so that you can educate the people around you.

Healthy People 2020

21 03 2011

In 1979, the U.S. Department of Health and Human Services’ (HHS) Healthy People program debuted in the form of a surgeon general’s report. Since then, every 10 years (starting in 1990), scientists meet to try and figure out what’s needed and what’s feasible for the good of public health. 

The updated Healthy People 2020 website has a full list of objectives, along with resources to help health departments and organizations achieve those objectives.

We spoke with Carter Blakey, Acting Deputy Director of the Office of Disease Prevention and Health Promotion (ODPHP), about how nongovernment organizations can get involved. “Health is very complex, there are lots of different factors,” Carter said. “It takes more than the federal government to change health.”

The Healthy People 2010 objectives were very ambitious, Carter admitted. All the goals rolled into achieving the objective of “eliminating disparities. The goals were set to be better than the best communities in the country.”

Carter said that some goals were set 1,000% above the national average. Some groups were very motivated by this and others were very discouraged because they thought the goals were impossible.

The 2020 goals are more realistic with a little bit of a stretch. “It will be interesting to see if we are able to meet more of our goals. Moving the needle takes a long time, many years.”

It’s up to States and organizations to tackle the objectives and make a real impact in their communities. While States are not required to participate in the Healthy People program, many do, and have a dedicated State Coordinator to help organize activity.

There is funding available for States, Territories, and Tribes that have an innovative plan to use Healthy People 2020 to improve a community’s health. The Healthy People Action Project proposals are due on April 1, 2011.

Beyond that specific grant, organizations can use the Healthy People benchmarks as data to support applications for grants or other funding opportunities by comparing their communities to the national average.

What goals are you most interested in tackling in the next decade? Where do you see the need to collaborate most to achieve these goals? We’d love to hear from you in our comments.

Happy St. Patrick’s Day: How the Celts handled hygiene

17 03 2011

A Celtic warrior, presumably fresh from a good bathe and very well manscaped (photo credit: Bart Vetters, via Creative Commons)

In honor of St. Patrick’s day, those of us at PKIDs with a wee bit o’ the Celt in our genes decided to look into the hygiene of our ancestors. Just how clean were those bodies wearin’ the green (or blue), anyway?

You may think that ancient peoples, like the Celtic tribes, didn’t practice great personal hygiene. It’s true that during the medieval period, you wouldn’t want to have been trapped in a crowded room just about anywhere in Europe. But for many ancient Celts, hygiene was an important part of their culture. Did you know that they often get credit for having invented soap, or at least for passing it off to the Romans? Before the Romans acquired this tallow-made cleanser, they used urine to clean just about everything, although for their skin, scented oils were the unguent of choice. The Iberian Celts suffered under the accusation that they brushed their teeth and washed with stale urine (ewww), but since the source of this information was a chronicler from the enemy’s side, it must be taken with a wee bit of salt.

Whether Celtic Gauls truly did introduce the Romans to using animal-fat soap (sheep tallow), as Pliny credits them, these ancient peoples certainly had a number of hygiene routines that were practically cultural laws. In fact, they were simply expected. For example, according to some sources, a Celtic warrior had to bathe before a meal or before battle.

Warriors (and possibly others) also were known for shaving their entire bodies (or maybe burning the hair off with lye–ouch) except for the mustache and head hair, which they grew very long. They would then paint themselves with blue dye from the woad plant to provide a terror-inducing visual for the enemy. In that long hair, the warriors used a lime-based pomade that turned their lengthy locks white. In other words, Celtic warriors manscaped.

In spite of the bathing and manscaping, practices at the table may not have been up to today’s norms. The Celtic style for aristocratic men was a long, handlebar-type mustache that, during eating, would capture bits of food that drinking strained away. Ewww, again. In spite of the soup-straining facial hair, however, the Celts were very much into shaving, which kept away pestilent vermin, and even had nail clippers to keep their fingernail growth in check.

Celts probably even washed their hands in the mornings with their tallow soaps and as they bathed. Given how embedded their cultural hygiene practices were, their hand-washing rates may have far exceeded today’s rates in the United States, which fall below 50% for many groups. Ahem, citizens of the United States. Are you going to let the ancient Celts out-do you in hygiene? This St. Patrick’s Day, we wish you the luck o’ the Irish…and Celtic hand-washing rates, as well.


Ryan is Hepatitis C+

14 03 2011

(Guest post from Nora, Ryan’s mom.)

courtesy sugar daze

As a little girl, I dreamed of being a wife and mother with a home filled with children. 

When I realized that “prince charming” wasn’t showing, I knew I could still be a mom.  When I set out on the journey alone, I thought it would take forever, however I was a lucky one.  I signed with an adoption agency in June of 2002, and my son was born in August 2002. 

When the agency told me they had a birthmother looking for a single mom, I questioned why? In speaking to the birthmom she said “she had grown up in a household where her parents fought a lot, so her thought was if there was one parent she was ok with that.”  Anyway, it worked out great for me. 

 The agency told me the mother was a drug user and had hepatitis B and C.  I thought “OK so what does that mean?”

I was able to get the birthmom’s medical records as well as my son’s records, once he was born, and have then reviewed.  At birth, my son’s blood was non-reactive to hepatitis C and of course he was given the vaccine for hepatitis B.  OK, non-reactive that’s good right?  Well it really doesn’t mean anything except that the virus is not active as of right now, and we would have to wait until he was 15 months old to run further blood work. 

 When I was asked if I still wanted to adopt him, I thought they were crazy, well of course.  He was my son, it was meant for me to be his mom and my blessing from above.  We plugged along with him over the first year having some issues, having to be withdrawn from the drugs he was born addicted to, having a bout of meningitis, bladder infections, a lot of virus issues etc.  Then the dreaded 15 month time frame was here. 

Ok we went and had the blood work and I just knew in my heart that since I had been told that there was less than a 1% chance that he would have hepatitis C that we would be doing this just to get the all clear.  I remember it was right before Thanksgiving and I was going into the mall to shop when my cell phone rang.  It was Ryan’s pediatrician who was a friend that I had worked with over the years.  I couldn’t believe what I was hearing, his blood work was positive for hepatitis C.  What, say that again?  You have to be wrong, right? 

No, he wasn’t wrong.  He told me to enjoy the holiday and he would see me right after.  Enjoy the holiday, are you kidding me, how would I ever enjoy anything again? 

You see for me the first 15 months of my son’s life was spent dealing with the other issues, and not ever really thinking that we would have to deal with HCV.  I didn’t really know a lot about it and my first thought was “Oh my God, I am going to have to watch my child suffer.” 

Well over the next week I began researching and reading everything I could on hepatitis.  By the time Ryan got in to see the GI specialist, I knew we had to run a genotype screening and viral load blood work.  I was in an attack mode and wanted my baby fixed.  Well I wish it was that easy.  The GI physician here at our local Childrens’ Hospital told me that there was not much info on children dealing with this disease and he would follow Ryan with blood work and ultrasounds every six months, and at age 3 we would treat him. 

WHAT, I wanted something done now.  Of course I realized in my mind that that was not the protocol and that I had to trust the doctors.  That was hard for me, I wanted to be in control over what happened with my son, not this horrible disease that could be eating away at his liver.  How would I allow it to go on for another 2 years before we did anything?  Of course, now I realize the harshness of the treatment, but at that time I just wanted it not to be true.  I prayed that I would be strong for my son and be able to gain as much knowledge as I could about this monster living within his blood and liver.  

(Ryan is finally in treatment.)

Sabina Gets Active Against HCV

10 03 2011

(Guest post in a series from Sabina, our 15-year-old friend living with hepatitis C.)

Dear Readers,
Yesterday, I had my fourth interferon shot! And I didn’t feel any pain.

Yes, I was anxious but when I actually got the shot it was easy. So far, I’m lucky that I have not had any symptoms after the shot.

Sometimes I get headaches, nausea, and tired from the ribavirin pills. But I still feel upbeat and I’m really glad that so far I can do the sports I love to do.

Courtesy: Meredith James Johnstone

Last Tuesday, I started dance classes for the first time and I’m having great loads of fun. This Friday I have tryouts for volleyball. I’m excited for that. I don’t know if I can keep up both sports but I’m going to try.

Beyond sports, I feel like I’ve been able to do most activities and work at school. I haven’t missed any time, although I’ve been pretty tired. I’ve been going to bed early, like around 8 instead of 11.  That’s a big difference but I’m tired and I get to the point where I can’t keep my eyes open any more. This makes it harder to get my homework finished, but if I work on managing my time I can get everything done.

My parents say that if I get too tired I will have to let some activities go. I realize I shouldn’t overwork myself. But it feels good to be active and to have goals set for myself. 

One question I have for my readers is this—are there any other kids out there who are like me and going through this or thinking about getting treated? What are your views? What are the obstacles you are running into? And are you having any serious symptoms? I would love to hear from other people.

Does Vaccination Prevent Cancer?

7 03 2011

The history of anxiety about possible negative effects of vaccines is long, tracing back at least as far as Benjamin Franklin. Countering these worries is the fact that vaccines are one of the greatest public health successes of our time, saving millions of lives worldwide.

Now we know that vaccine benefits may extend beyond prevention of the target childhood disease.

An already recognized extra benefit comes with the vaccines for varicella. A varicella vaccine not only can prevent chickenpox in young people, but may also stop the occurrence of shingles in older folks.

Shingles, a neurological attack by the chickenpox virus decades after an infection, can cause a rash that leaves behind chronic, unbearable pain. Vaccination in childhood may protect against shingles, and according to a new study from a Texas group, published in The Journal of Pediatrics, childhood vaccines may offer reduced odds of childhood cancer.

The researchers, going on hints from earlier studies, looked at vaccine rates in specific areas and compared those numbers to childhood cancer rates in the same region. While childhood cancers are rare, they are, of course, devastating. The most common cancers in children are leukemia and brain and spinal cord cancers. According to previous studies, some common childhood infections might increase a child’s risk of leukemia, while vaccinations might reduce that risk. It’s not a nutty idea that some infections—especially viral infections—might be associated with cancer. Indeed, a few viral infections have an established association, including human papillomavirus (HPV, associated with cervical and anal cancers), hepatitis B (associated with liver cancer), and Epstein-Barr (the “mono” virus, linked to a type of lymphoma).

The researchers looked at the 2800 cases of childhood cancer diagnosed in Texas from 1995 to 2006, focusing only on cases diagnosed in children two years or older. For every child diagnosed with cancer, the team identified four more children who had not had cancer, matched for age and sex. As a final step, they then mapped how many children from each group had been born in Texas counties with high vaccination rates.

Their results showed that where hepatitis B vaccination rates were high, odds of all childhood cancers fell by almost 20%. Where rates of inactivated polio virus, hepatitis B, or a specific mix of childhood vaccinations were high, odds of finding cases of a common childhood leukemia, acute lymphoblastic leukemia (ALL), dropped by as much as 38%. The biggest dip in odds came with higher rates of Hib (Haemophilus influenzae type b) vaccine and ALL, with a 42% decrease in ALL odds where Hib vaccination rates were high.

It’s important to remember that the authors didn’t establish a cause–effect link here. This study is based on the numbers, and the take-home message here is a simple one. The authors put it best in their abstract: “Some common childhood vaccines appear to be protective against ALL at the population level.”


3 03 2011

(Guest post by Paula and Oscar Abalahin, Jaxon’s parents)

This is our beautiful son, Jaxon.  We adopted this sweet, smart, kind, and very active boy in 2001 when he was a toddler. For several years, we lived a normal, happy life.

Then one day, in February 2006, after a great day in kindergarten, Jax had some difficulty talking and his head was nodding, quickly dropping forward every three to five seconds.  His pediatrician thought Jax was having seizures, and we were referred to a pediatric neurologist. 

The next four months were spent in and out of hospitals, numerous tests were done, and many drugs were tried as his condition worsened to the point that the seizures prevented him from walking and he was no longer able to speak or even hold his head up. 

The doctors didn’t know what was causing these seizures and the best diagnosis they had was Idiopathic (no known cause) Epilepsy with intractable seizures.

We weren’t satisfied with that diagnosis, and searched the Internet trying to match his symptoms with a disease or disorder, but found nothing different than what our doctors had already found. 

We looked back at Jaxon’s medical history to see if anything he’d had could cause seizures.  Jaxon contracted measles at seven months of age, and we found that there was a rare condition closely matching his symptoms that was caused by the measles virus.

After the doctors reviewed his medical history from the Philippines, they diagnosed Subacute Sclerosing Panencephalitis (SSPE), a chronic persistent infection of the central nervous system caused by the measles virus, specifically an altered form of the measles virus.  

SSPE is almost always fatal within one to three years of onset, and has only a five percent chance of remission, and that slight chance depended on an early diagnosis and very specific treatment.

Because SSPE is rare, our neurologist needed a consult and found someone in Southern California who had treated a number of SSPE patients in the 1990s.

Over the next two years, our lives were consumed with hospital visits and exams and treatments.  Every day was a struggle, but he never gave up.  Jax always had a sparkle in his eyes, an incredible smile, and an infectious laugh that made you believe all was good.  But, in the end, he was hit hard with infections.  Despite his drive, his beautiful smile was slowly disappearing.  His body was worn down, although he never stopped fighting.

Jaxon would never want anyone else to suffer.  His fight to beat SSPE is our driving force.  We will continue raising awareness and looking for the cure, the cure we wanted for Jax. 

We are so proud of our son, our Super Hero, our Cracker Jax.