CDC

alarming-superbug-from-deadly-eyedrop-outbreak-has-spread-to-dogs

Alarming superbug from deadly eyedrop outbreak has spread to dogs

antibiotics, CDC, drug resistance, eyedrop, EzriCare, fda, infectious diseases, outbreak, Pseudomonas aeruginosa, Science / /

gone to the dogs —

It’s unclear how the dogs became infected with the same strain in the eyedrops.

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A dog gets examined by veterinary technicians in Texas.

Enlarge / A dog gets examined by veterinary technicians in Texas.

Two separately owned dogs in New Jersey tested positive last year for a dreaded, extensively drug resistant bacterial strain spread in the US by contaminated artificial eye drops manufactured in India. Those drops caused a deadly multi-state outbreak in humans over many months last year, with at least 81 people ultimately infected across 18 states. Fourteen people lost their vision, an additional four had eyeballs surgically removed, and four people died.

The preliminary data on the dogs—presented recently at a conference of disease detectives hosted by the Centers for Disease Control and Prevention—highlights that now that the deadly outbreak strain has been introduced around the US, it has the potential to lurk in unexpected places, spread its drug resistance to fellow bacteria, and cause new infections in people and animals who may have never used the drops.

The two dogs in New Jersey were not known to have received the drops linked to the outbreak: EzriCare Artificial Tears and two additional products made by the same manufacturer, which were recalled in February 2023. Such over-the-counter products are sometimes used in animals as well as people. But the dogs’ separate owners said they didn’t recall using the drops either. They also didn’t report any exposures in health care settings or recent international travel that could explain the infections. One of the dogs did, at one point, receive eye drops, but they were not an outbreak-associated brand. The only connection between the two dogs was that they were both treated at the same veterinary hospital, which didn’t stock the outbreak-associated eyedrops.

The dogs’ infections were caught between March and June 2023 when clinicians at the veterinary hospital were working to address a chronic cough in one of the dogs and a stubborn ear infection in the other, according to CBS News, which was present for the CDC’s conference of its Epidemic Intelligence Service in Atlanta. The ear and lung swabs were sent to an academic veterinary laboratory in Pennsylvania, where a microbiologist noticed that bacteria from both swabs had uncommon drug-resistance features. The microbiologist then uploaded genetic sequences of the bacterial strains to a national database, where they caught the attention of the CDC and state health authorities.

The genetic sequences uploaded were of the carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) strain—and they were highly similar to the bacterial strain identified in the deadly eyedrop outbreak. These bacteria are extensively resistant to antibiotics, resisting even last-line drugs, and can silently colonize animals and humans for months or years. An investigation ensued.

Infection gaps

Emma Price, the CDC epidemic intelligence service officer who presented the investigation’s findings at the conference, suggested it was fortunate they were able to make the connection. “Because [the academic veterinary laboratory] had a grant and a veterinary microbiologist works there, he did his great due diligence and uploaded the results. That’s how we got the notification, because the strain matched the outbreak strain,” Price told CBS News.

However, the disease detectives were ultimately unable to identify exactly how the two dogs became infected. “Shared exposures included treatment in the veterinary hospital’s surgical preparation and recovery areas for both canines and ophthalmology department visits by either the affected canine or another animal in the same household,” Price and colleagues wrote in their findings. But all of the sampling done of the veterinary hospital where the dogs were treated turned up negative for the eyedrop outbreak strain.

In the process of the investigation, the epidemiologists also conducted an infection control assessment of the veterinary hospital, finding a variety of “gaps.” These included problems with hand hygiene practices, personal protective equipment use—including use of gloves—and equipment and environmental cleaning and disinfection at the hospital. Price noted that these problems are not uncommon and that there is a general lack of emphasis on infection control in veterinary settings.

Though Price and her colleagues were unable to identify the direct route of infection, they suspect the dogs were likely infected either by exposure to a contaminated product or secondary transmission at the veterinary hospital.

Both dogs have since made full recoveries, but because CRPA strains can silently colonize many body sites on both humans and animals, it’s possible that the bacteria still linger on the dogs or on the other pets and people in their households. Price warned the owners of possible future transmission and recommended they flag this risk to their health care providers. She also noted the potential for the bacteria to spread from dog to dog. It would be ideal to “keep the dogs away from other dogs in the future, which we understand is a difficult thing to do,” she said.

Alarming superbug from deadly eyedrop outbreak has spread to dogs Read More »

20%-of-grocery-store-milk-has-traces-of-bird-flu,-suggesting-wider-outbreak

20% of grocery store milk has traces of bird flu, suggesting wider outbreak

bird flu, CDC, cows, fda, H5N1, health, Infectious disease, milk, Science, USDA, virus / /

widespread —

The milk is still considered safe, but disease experts are alarmed by the prevalence.

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20% of grocery store milk has traces of bird flu, suggesting wider outbreak

The Food and Drug Administration reported late Thursday that about 20 percent of retail milk samples from around the country tested positive for genetic fragments of the bird flu, aka highly pathogenic avian influenza (HPAI) virus H5N1. While retail milk is still considered to be safe, the finding suggests that the spread of the virus in cows is more extensive than is currently known.

The FDA used a test called quantitative polymerase chain reaction (qPCR), which can only detect the presence of genetic fragments. In pasteurized retail milk, it is highly likely that those genetic snippets are merely remnants of virus particles destroyed during pasteurization. The FDA is currently conducting additional testing using egg inoculation tests, a gold standard for detecting a live virus, to confirm the effectiveness of pasteurization. Meanwhile, the director of the National Institute of Allergy and Infectious Diseases, Jeanne Marrazzo, told reporters Wednesday that tests at the agency’s federal labs so far did not identify live virus from any of its sampling. Additionally, several previous studies have found that pasteurization of eggs—which is done at a lower temperature than it is for milk—was effective at destroying H5N1.

While experts are largely unconcerned with the safety of commercial milk, the potential for wide, unrecognized spread of bird flu in dairy herds is alarming. To date, the US Department of Agriculture has only confirmed infections in 33 herds in eight states. The FDA acknowledged that of its positive samples, “a greater proportion of positive results [are] coming from milk in areas with infected herds.” But with tens of thousands of dairy herds in the US, the finding suggests that infections are being missed. It does not necessarily suggest that 20 percent of all cows are affected, since milk is pooled for commercial distribution. But 33 herds alone are unlikely to explain the high prevalence.

Last week, The New York Times reported that the one dairy herd that tested positive for bird flu in North Carolina did not show any symptoms of the infection. The possibility of asymptomatic spread of the virus among cows will make containment and monitoring far more difficult—and could explain why infections may be easily missed. On Wednesday, the USDA issued a federal order requiring dairy cattle to have a negative H5N1 test before being moved across state lines.

For now, the risk to the public is still considered low by the Centers for Disease Control and Prevention. But the more the bird flu virus spreads among mammals—and mammals with close contact with humans—the more opportunities it has to evolve to jump to and among people, experts warn.

20% of grocery store milk has traces of bird flu, suggesting wider outbreak Read More »

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Three women contract HIV from dirty “vampire facials” at unlicensed spa

CDC, health, HIV, Infectious disease, outbreak, outbreak investigation, platelet-rich plasma, Science, spa, vampire facials / /

Yikes —

Five patients with links to the spa had viral genetic sequences that closely matched.

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Drops of the blood going onto an HIV quick test.

Enlarge / Drops of the blood going onto an HIV quick test.

Trendy, unproven “vampire facials” performed at an unlicensed spa in New Mexico left at least three women with HIV infections. This marks the first time that cosmetic procedures have been associated with an HIV outbreak, according to a detailed report of the outbreak investigation published today.

Ars reported on the cluster last year when state health officials announced they were still identifying cases linked to the spa despite it being shut down in September 2018. But today’s investigation report offers more insight into the unprecedented outbreak, which linked five people with HIV infections to the spa and spurred investigators to contact and test nearly 200 other spa clients. The report appears in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The investigation began when a woman between the ages of 40 and 50 turned up positive on a rapid HIV test taken while she was traveling abroad in the summer of 2018. She had a stage 1 acute infection. It was a result that was as dumbfounding as it was likely distressing. The woman had no clear risk factors for acquiring the infection: no injection drug use, no blood transfusions, and her current and only recent sexual partner tested negative. But, she did report getting a vampire facial in the spring of 2018 at a spa in Albuquerque called VIP Spa.

“Vampire facial” is the common name for a platelet-rich plasma microneedling procedure. In this treatment, a patient’s blood is drawn, spun down to separate out plasma from blood cells, and the platelet-rich plasma is then injected into the face with microneedles. It’s claimed—with little evidence—that it can rejuvenate and improve the look of skin, and got notable promotions from celebrities, including Gwyneth Paltrow and Kim Kardashian.

The woman’s case led investigators to VIP Spa, which was unlicensed, had no appointment scheduling system, and did not store client contact information. In an inspection in the fall of 2018, health investigators found shocking conditions: unwrapped syringes in drawers and counters, unlabeled tubes of blood sitting out on a kitchen counter, more unlabeled blood and medical injectables alongside food in a kitchen fridge, and disposable equipment—electric desiccator tips—that were reused. The facility also did not have an autoclave—a pressurized oven—for sterilizing equipment.

A novel and challenging investigation

The spa was quickly shut down, and the owner Maria de Lourdes Ramos De Ruiz, 62, was charged with practicing medicine without a license. In 2022, she pleaded guilty to five counts and is serving a three-and-a-half-year prison sentence.

A second spa client, another woman between the ages of 40 and 50, tested positive for HIV in a screen in the fall of 2018 and received a diagnosis in early 2019. She has received a vampire facial in the summer of 2018. Her HIV infection was also at stage 1. Investigators scrambled to track down dozens of other clients, who mostly spoke Spanish as their first language. The next two identified cases weren’t diagnosed until the fall of 2021.

The two cases diagnosed in 2021 were sexual partners: a woman who received three vampire facials in the spring and summer of 2018 from the spa and her male partner. Both had a stage 3 HIV infection, which is when the infection has developed into Acquired Immunodeficiency Syndrome (AIDS). The severity of the infections suggested the two had been infected prior to the woman’s 2018 spa treatments. Health officials uncovered that the woman had tested positive in an HIV screen in 2016, though she did not report being notified of the result.

The health officials reopened their outbreak investigation in 2023 and found a fifth case that was diagnosed in the spring of 2023, which was also in a woman aged 40 to 50 who had received a vampire facial in the summer of 2018. She had a stage 3 infection and was hospitalized with an AIDS-defining illness.

Viral genetic sequencing from the five cases shows that the infections are all closely related. But, given the extent of the unsanitary and contaminated conditions at the facility, investigators were unable to determine precisely how the infections spread in the spa. In all, 198 spa clients were tested for HIV between 2018 and 2023, the investigators report.

“Incomplete spa client records posed a substantial challenge during this investigation, necessitating a large-scale outreach approach to identify potential cases,” the authors acknowledge. However, the investigation’s finding “underscores the importance of determining possible novel sources of HIV transmission among persons with no known HIV risk factors.”

Three women contract HIV from dirty “vampire facials” at unlicensed spa Read More »

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Fragments of bird flu virus genome found in pasteurized milk, FDA says

avian influenza, bird flu, CDC, cows, dairy cows, fda, flu, H5N1, Infectious disease, influenza, milk, pasteurization, Science, Uncategorized / /

Milk testing —

The test cannot tell if the virus is live. The FDA still assess milk supply as safe.

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Cows being milked

Enlarge / Cows being milked

The Food and Drug Administration on Tuesday announced that genetic fragments from the highly-pathogenic avian influenza virus H5N1 have been detected in the pasteurized, commercial milk supply. However, the testing completed so far—using quantitative polymerase chain reaction (qPCR)—only detects the presence of viral genetic material and cannot tell whether the genetic material is from live and infectious viral particles or merely remnants of dead ones killed by the pasteurization process.

Testing is now ongoing to see if viable, infectious H5N1 can be identified in milk samples.

So far, the FDA still believes that the milk supply is safe. “To date, we have seen nothing that would change our assessment that the commercial milk supply is safe,” the agency said in a lengthy explanation of the finding and ongoing testing.

H5N1 made its startling jump to US dairy cows recently, with the first ever documented cases in a Texas herd confirmed on March 25. It has spread widely since then with at least 32 herds in eight states now known to be infected. The unexpected spread to bovines has raised fears that the virus is evolving to infect mammals more efficiently, and so poses a heightened risk of spread to and among humans.

But amid the alarming outbreak among the country’s dairy herds, federal agencies have appeared confident that the virus poses little risk to no risk to the safety of the milk supply.

“At this time, there continues to be no concern that this circumstance poses a risk to consumer health, or that it affects the safety of the interstate commercial milk supply because products are pasteurized before entering the market” the FDA wrote in an FAQ published Friday. “Pasteurization has continually proven to inactivate bacteria and viruses, like influenza, in milk.”

In the announcement Tuesday, the FDA also highlighted that multiple studies have shown that the pasteurization process for eggs, which uses lower temperatures than what is used for milk, is effective at inactivating H5N1.

Nevertheless, the FDA, along with the Centers for Disease Control and Prevention and the US Department of Agriculture, have continued to investigate potential risks, including establishing whether pasteurization can inactivate this specific virus. The FDA noted in its announcement Tuesday that, while pasteurization is expected to kill the virus, pasteurization is “different than complete sterilization.”

As such, it carried out the qPCR tests, expecting it might find some genetic fragments in the pasteurized milk because virus has been detected in raw milk. “Based on available information, pasteurization is likely to inactivate the virus, however the process is not expected to remove the presence of viral particles,” the FDA explained. “Therefore, some of the samples collected have indicated the presence of HPAI [Highly Pathogenic Avian Influenza] using quantitative polymerase chain reaction (qPCR) testing.”

The FDA did not indicate how many samples it has tested, where the samples were collected from, or the level of viral genetic material the samples contained.

The agency is now working on assessing whether it can identify if any virus particles are infectious using egg inoculation tests, which are considered a gold-standard for determining viral viability. It added that it will release results from those tests and others in “the next few days to weeks.”

“[W]e take this current situation and the safety of the milk supply very seriously. We recognize the importance of releasing further, actionable information,” the FDA said.

Meanwhile, the agency reported that the CDC’s food safety group has been closely monitoring emergency department data and flu testing data for any unusual trends in flu-like illness, flu, or conjunctivitis, which could indicate spread of H5N1 to people. “To date, surveillance systems do not show any unusual trends or activity,” the FDA said.

Fragments of bird flu virus genome found in pasteurized milk, FDA says Read More »

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Concern grows as bird flu spreads further in US cows: 32 herds in 8 states

avian influenza, bird flu, CDC, cows, dairy cows, fda, H5N1, herds, infection, milk, outbreak, Science, USDA, virus / /

Rapidly evolving —

Experts say the US is not sharing as much data on the outbreak as it should.

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Greylag geese sit on a field and rest while a cow passes by in the background.

Enlarge / Greylag geese sit on a field and rest while a cow passes by in the background.

Researchers around the world are growing more uneasy with the spread of highly pathogenic avian influenza (H5N1) in US dairy cows as the virus continues to make its way into new herds and states. Several experts say the US is not sharing enough information from the federal investigation into the unexpected and growing outbreak, including genetic information from isolated viruses.

To date, the US Department of Agriculture has tallied 32 affected herds in eight states: Idaho, Kansas, Michigan, New Mexico, North Carolina, Ohio, South Dakota, and Texas. In some cases, the movement of cattle between herds can explain the spread of the virus. But the USDA has not publicly clarified if all the herds are linked in a single outbreak chain or if there is evidence that the virus has spilled over to cows multiple times. Early infections in Texas were linked to dead wild birds (pigeons, blackbirds, and grackles) found on dairy farms. But the USDA reportedly indicated to Stat News that the infections do not appear to be all linked to the Texas cases.

Spread of the virus via cattle movements indicates that there is cow-to-cow transmission occurring, the USDA said. But it’s unclear how the virus is spreading between cows. Given that even the most symptomatic cows show few respiratory symptoms, the USDA speculates that the most likely way it is spreading is via contaminated milking equipment.

Adding to the uncertainty of the virus’s spread, The New York Times on Friday reported that the one herd found infected with H5N1 in North Carolina showed no symptoms of the virus. This raises the possibility that the virus could be silently spreading in unknown numbers of other asymptomatic herds and states. In its most recent FAQ document, the USDA encouraged testing for H5N1 if herds show clinical symptoms, such as lethargy, fever, low milk production, and loose stools. But the Times noted that the agency has begun reimbursing farms for testing asymptomatic cows.

Meanwhile, the USDA also reported that it has evidence that H5N1 from dairy farms has spread back into birds in nearby poultry farms, but how this is happening is also unknown.

Data gaps

All the uncertainty and widespread transmission raises concern about how the virus is evolving to infect mammals and whether it is heading for humans. Last week, the chief scientist for the World Health Organization, Jeremy Farrar, told reporters in Geneva that the spread of the virus in US dairy cows is an “enormous concern,” according to CNN.  “The great concern, of course, is that in doing so and infecting ducks and chickens—but now increasingly mammals—that that virus now evolves and develops the ability to infect humans. And then critically, the ability to go from human-to-human transmission.”

In particular, experts are wary that the dairy cow outbreaks could spill over to nearby pig farms as it’s doing with nearby poultry farms. Pigs can be infected with both bird flu viruses and human flu viruses, making them potential melting pots for new recombinant flu strains.

So far, the USDA says that genetic sequences of H5N1 viruses infecting cows has not revealed any mutations that “would make it more transmissible to humans and between people.” But last Thursday, Stat reported that international experts have faulted the USDA for not sharing more genetic data from its investigation, among other information. Until this weekend, the agency had only shared a few genetic sequences in an international database of viral genome sequences (GISAID).

“A country with capacity like the United States should be able to generate this information within days,” Marion Koopmans, head of the department of viroscience at Erasmus Medical Center in the Dutch city of Rotterdam told Stat last week. “I would expect very fast, very transparent updates, and it’s somewhat amazing not to see that happening.”

On Sunday, facing mounting criticism, the USDA announced the release of 239 genetic sequences to GISAID. It noted it is also adding raw data to a US federal database “in the interest of public transparency and ensuring the scientific community has access to this information as quickly as possible.” The agency said it will continue to make such data available on a rolling basis.

Dr. Rosemary Sifford, the USDA’s chief veterinarian, told the Times, “Please recall that we’ve been engaged in this for less than a month. We are working very hard to generate more information,” she said.

Overall, the USDA and the US Centers for Disease Control and Prevention continue to consider the risk to the public to be low. Farmworkers and others who have direct contact with infected animals are encouraged to take precautions, however.

While deadly to birds, H5N1 in cows is relatively mild, rarely if ever causing deaths. Milk from sick animals contains high levels of virus, but it is being destroyed. Even if some infected milk makes its way into the milk supply, the Food and Drug Administration is confident that the virus would be killed in the pasteurization process. “Pasteurization has continually proven to inactivate bacteria and viruses, like influenza, in milk,” the agency said in an FAQ Friday. Some experts have called for data confirming this, though.

Concern grows as bird flu spreads further in US cows: 32 herds in 8 states Read More »

bogus-botox-poisoning-outbreak-spreads-to-9-states,-cdc-says

Bogus Botox poisoning outbreak spreads to 9 states, CDC says

botox, botulism, CDC, health, injection, outbreak, Science / /

botched shots —

All of the case have been in women, nine of whom were hospitalized.

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A package of counterfeit Botox.

A package of counterfeit Botox.

At least 19 women across nine US states appear to have been poisoned by bogus injections of Botox, the Centers for Disease Control and Prevention reported late Monday.

Nine of the 19 cases—47 percent—were hospitalized and four—21 percent—were treated with botulinum anti-toxin. The CDC’s alert and outbreak investigation follows reports in recent days of botulism-like illnesses linked to shady injections in Tennessee, where officials reported four cases, and Illinois, where there were two. The CDC now reports that the list of affected states also includes: Colorado, Florida, Kentucky, Nebraska, New Jersey, New York, and Washington.

In a separate alert Tuesday, the Food and Drug Administration said that “unsafe, counterfeit” versions of Botox had been found in several states, and the toxic fakes were administered by unlicensed or untrained people and/or in non-medical or unlicensed settings, such as homes or spas. The counterfeit products appeared to have come from an unlicensed source, generally raising the risks that they’re “misbranded, adulterated, counterfeit, contaminated, improperly stored and transported, ineffective and/or unsafe,” the FDA said.

The CDC and the FDA listed the various symptoms that followed injections of the counterfeit Botox, which include: blurred or double vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, constipation, incontinence, shortness of breath or difficulty breathing, weakness, and difficulty lifting one’s head. “These symptoms are similar to those seen when botulinum toxin spreads to other parts of the body,” the FDA wrote. Anyone experiencing those symptoms after an injection should go to the emergency room or contact a health care professional.

Botox is a regulated drug containing purified, controlled doses of botulinum toxin, a neurotoxin made by Clostridium bacteria that causes muscle paralysis by blocking a neurotransmitter. It’s often injected into the face to reduce the appearance of wrinkles. The CDC reported that all 19 cases identified so far are in women between the ages of 25 and 59. Eighteen of the 19 specifically reported getting the injections for cosmetic purposes.

But harmful exposure to the toxin—such as from an infection, eating contaminated foods, or use of counterfeit Botox—can cause botulism or at least botulism-like illnesses. In severe cases, botulism can progress to descending, symmetric muscle weakness, full muscle paralysis, and can sometimes be fatal. The CDC reported that some of the people in the outbreak were hospitalized and treated with anti-toxin out of concern that the toxin had spread beyond the injection site. However, the agency noted that five people were specifically tested for botulism, and all tested negative.

In an email to Ars late last week, the CDC recommended that anyone interested in a Botox injection do so using “an FDA-approved product, administered by licensed providers and in licensed settings.” The agency added in its alert Monday: ” If in doubt, don’t get the injection.”

The FDA, meanwhile, provided detailed information on how to ensure your shot of Botox is the real thing. FDA-approved Botox is made by AbbVie, and authentic Botox products come in unit doses of 50, 100, and 200. The outside of the box should say “BOTOX® COSMETIC / onabotulinumtoxinA / for Injection” or “OnabotulinumtoxinA / BOTOX® / for injection,” and it should list the manufacturer as either “Allergan Aesthetics / An AbbVie Company” or “abbvie.” The active ingredient should be listed as “OnabotulinumtoxinA” on the box.

In contrast, some of the counterfeit versions the FDA has tracked down so far were sold in 150-unit doses (not made by AbbVie), only appear to have “Allergan” on the box (not the full manufacturer name), and the active ingredient is displayed as “Botulinum Toxin Type A” instead of  “OnabotulinumtoxinA.” The counterfeit versions also have had non-English language text on the outside of the box and displayed a lot number of C3709C3. Any one of these features is a sign that the product is counterfeit. Images of the counterfeit products from the FDA are below.

Bogus Botox poisoning outbreak spreads to 9 states, CDC says Read More »

sketchy-botox-shots-spark-multistate-outbreak-of-botulism-like-condition

Sketchy Botox shots spark multistate outbreak of botulism-like condition

botox, botulism, butulinum toxin, CDC, health, Illinois, Science, tennessee / /

Yikes —

So far at least six people in two states have fallen ill; four of them were hospitalized.

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A woman in New Jersey receiving a Botox treatment at a Botox party in a New Jersey salon hosted by a radio station.

Enlarge / A woman in New Jersey receiving a Botox treatment at a Botox party in a New Jersey salon hosted by a radio station.

Sketchy cosmetic injections of what seem to be counterfeit Botox are behind a multistate outbreak of botulism-like illnesses, state health officials report.

So far, at least six people have fallen ill in two states: four in Tennessee and two in Illinois. Four of the six people required hospitalization for their condition (two in Tennessee and both cases in Illinois).

The Centers for Disease Control and Prevention is reportedly planning to nationwide alert to notify clinicians of the potentially counterfeit Botox and advise them to be on the lookout for botulism-like illnesses. The agency did not immediately respond to Ars’ request for information.

Botox is a regulated drug product that contains purified, controlled quantities of the botulinum neurotoxin, which is made by certain Clostridium bacterial species, especially Clostridium botulinum. The toxin causes muscle paralysis by blocking the release of a neurotransmitter. When people are exposed to the toxin from wound infections or by accidentally eating contaminated foods, it can lead to full paralysis, including in muscles used for breathing. But, the toxin can also be used safely for cosmetic procedures to smooth facial wrinkles—when well-regulated and approved doses administered by licensed medical professionals are used.

All of those important conditions for use did not seem to be met in the cases identified so far. Tennessee reported that its four cases were linked to injections given in “non-medical settings such as homes or cosmetic spas.” Investigators found that the injections were of “products with unclear origin” and that information collected so far suggests the products were counterfeit.

The two people sickened in Illinois, meanwhile, both received injections from a nurse in LaSalle County who was “performing work outside her authority.” State officials said the injections were of Botox or a similar, possibly counterfeit product.

The early symptoms of botulism can include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and difficulty breathing, Tennessee health officials noted. After that, people may suffer descending, symmetric muscle weakness that progresses over hours to days, requiring hospitalization and treatment with an anti-toxin.

Illinois officials reported that the cases reported similar symptoms, such as blurred or double vision, droopy face, fatigue, shortness of breath, difficulty breathing, and a hoarse voice, after getting their injections.

“Illinois residents should exercise caution when considering cosmetic treatment,” Illinois Department of Public Health Director Sameer Vohra said in a statement. “Receiving these treatments in unlicensed, unapproved settings can put you or your loved ones at serious risk for health problems. Please only seek cosmetic services under the care of licensed professionals trained to do these procedures and who use FDA approved products. If you are experiencing any health problems after a recent cosmetic treatment, please contact your healthcare provider immediately for help and assistance.”

Sketchy Botox shots spark multistate outbreak of botulism-like condition Read More »

hong-kong-monkey-encounter-lands-man-in-icu-with-rare,-deadly-virus

Hong Kong monkey encounter lands man in ICU with rare, deadly virus

B virus, CDC, health, Hong Kong, ICU, infection, macaques, Monkey, Science / /

rare but deadly —

The man had recently visited a country park known for its macaque monkeys.

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This photo taken in August 2014 shows macaque monkeys in a country park in Hong Kong.

Enlarge / This photo taken in August 2014 shows macaque monkeys in a country park in Hong Kong.

A 37-year-old man is fighting for his life in an intensive care unit in Hong Kong after being wounded by monkeys during a recent park visit and contracting a rare and deadly virus spread by primates.

The man, who was previously in good health, was wounded by wild macaque monkeys during a visit to Kam Shan Country Park in late February, according to local health officials. The park is well known for its conservation of wild macaques and features an area that locals call “Monkey Hill” and describe as a macaque kingdom.

On March 21, he was admitted to the hospital with a fever and “decreased conscious level,” health officials reported. As of Wednesday, April 3, he was in the ICU listed in critical condition. Officials reported the man’s case Wednesday after testing of his cerebrospinal fluid revealed the presence of B virus.

B virus, also known as herpes B virus or herpesvirus simiae, is a common infection in macaques, usually causing asymptomatic or mild disease. Infections in humans are extremely rare, but when they occur, they usually come from macaque encounters and are often severe and deadly. The infection can start out a lot like the flu, but the virus can move to the brain and spinal cord, causing brain damage, nerve damage, and death. The US Centers for Disease Control and Prevention estimates that about 70 percent of untreated infections in humans are fatal.

Despite the presence of macaques around Hong Kong, the man’s case is the first known B virus infection documented there. The virus was discovered in 1932, and since then only 50 human infections have been documented as of 2019, the CDC reports. Of those 50 people infected, 21 died. The agency notes that in one case, from 1997, a researcher was infected and died after bodily fluid from an infected monkey splashed into her eye. Still, contracting the virus is rare, even among people exposed to macaques. The CDC reports that there are hundreds of reports of macaque bites and scratches each year in US animal facilities, and infections remain very uncommon.

However low the risk, health officials recommend keeping your distance from wild monkeys and not feeding or touching them. If you are bitten or scratched, wash the wound immediately and seek medical attention.

Hong Kong monkey encounter lands man in ICU with rare, deadly virus Read More »

bird-flu-flare:-cattle-in-5-states-now-positive-as-texas-egg-farm-shuts-down

Bird flu flare: Cattle in 5 states now positive as Texas egg farm shuts down

bird flu, CDC, Chickens, dairy cows, eggs, health, hens, Highly pathogenic avian influenza, influenza, Science, USDA / /

flare-up —

The risk to the general public remains low, federal officials say.

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Chicken eggs are disposed of at a quarantined farm with bird flu in Israel's northern village of Margaliot on January 3, 2022.

Enlarge / Chicken eggs are disposed of at a quarantined farm with bird flu in Israel’s northern village of Margaliot on January 3, 2022.

The flare-up of highly pathogenic bird flu continues to widen in US livestock after federal officials confirmed last week that the virus has spread to US cows for the first time. The virus has now been detected in dairy cows in at least five states, a single person in Texas exposed to infected cows, and an egg farm in Texas, all spurring yet more intense monitoring and biosecurity vigilance as the situation continues to evolve.

As of Tuesday, seven dairy herds in Texas, two in Kansas, and one each in Idaho, Michigan, and New Mexico had tested positive for the virus. The affected dairy herd in Michigan had recently received cows from one of the infected herds in Texas. It remains unclear if there is cow-to-cow transmission of the flu virus.

The virus—a highly pathogenic H5N1 avian influenza or HPAI—has been devastating wild birds worldwide for the past several years. Throughout the devastating outbreak, the flu virus has spilled over to various species, including big cats in zoos, river otters, bears, dolphins, seals, squirrels, and foxes. While cows were an unexpected addition to the list, federal officials noted last week that affected dairy farms had found dead wild birds on their farms, suggesting that wild birds introduced the virus to the cows, not an intermediate host.

On Monday, the Centers for Disease Control and Protection reported that a person in Texas who had contact with infected dairy cows had tested positive for the HPAI. The person’s only symptom was eye redness. The CDC said the person was treated with an antiviral for flu and was recovering. It is the second case of HPAI found in a person in the US. The first case was in a person in Colorado who was directly exposed to poultry infected with the virus. In that case, the person’s only symptom was fatigue over a few days. The person recovered. The CDC considers the risk of HPAI to the general public to be low.

Low risk

Meanwhile, the virus continues to spread to less-surprising animals: chickens. On Tuesday, Cal-Maine Foods, Inc., the country’s largest producer of fresh eggs, reported that HPAI was detected in one of its facilities in Texas. The facility is located in Parmer County, which sits at the border of Texas and New Mexico. It’s unclear if the egg facility is close to any of the affected dairy herds. Cal-Maine, following the US Department of Agriculture biosecurity protocols, immediately shut down the facility. Approximately 1.6 million hens and 337,000 pullets—young hens—were culled. Cal-Maine said the hens represented about 3.6 percent of the company’s total flock.

Since the outbreak began in wild birds, the virus has led to the deaths of over 82 million commercial and backyard birds in the US, with 48 states affected and over 1,000 outbreaks reported. The infections have spurred increases in egg and poultry prices.

It’s unclear if the virus will have the same effect on milk or beef, but so far, it appears that it will not. In the infected herds, the virus appears to only be affecting a small percentage of animals, particularly older animals, and they generally recover. As the USDA puts it there’s “little to no associated mortality reported.” Milk from sick cows is always diverted from the milk supply, but even if milk contaminated with HPAI were to make it into the supply, the virus would be destroyed in the pasteurization process.

Still, the continued, widespread outbreak and spillovers of HPAI in various species highlight the ever-present risk that influenza viruses could mix together, combining genetic fragments of different strains (genetic reassortment) to create a new strain that could spark outbreaks or even a pandemic in humans. In the current outbreak among dairy cattle, federal researchers were quick to check the genetic sequence of the HPAI, finding that, so far, the strain lacks mutations in key genetic regions that would signal the virus has become more infectious to humans. For now, the USDA and the CDC report that the risk to the public is low.

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China has a big problem with super gonorrhea, study finds

antibiotic, antibiotic resistance, bacterial infection, CDC, ceftriaxone, china, drug resistance, gonorrhea, health, Science, sexually transmitted infection, sti / /

Alarming —

Drug-resistant gonorrhea is a growing problem—one that doesn’t heed borders.

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A billboard from the AIDS Healthcare Foundation is seen on Sunset Boulevard in Hollywood, California, on May 29, 2018, warning of a drug-resistant gonorrhea.

Enlarge / A billboard from the AIDS Healthcare Foundation is seen on Sunset Boulevard in Hollywood, California, on May 29, 2018, warning of a drug-resistant gonorrhea.

Health officials have long warned that gonorrhea is becoming more and more resistant to all the antibiotic drugs we have to fight it. Last year, the US reached a grim landmark: For the first time, two unrelated people in Massachusetts were found to have gonorrhea infections with complete or reduced susceptibility to every drug in our arsenal, including the frontline drug ceftriaxone. Luckily, they were still able to be cured with high-dose injections of ceftriaxone. But, as the US Centers for Disease Control and Prevention bluntly notes: “Little now stands between us and untreatable gonorrhea.”

If public health alarm bells could somehow hit a higher pitch, a study published Thursday from researchers in China would certainly accomplish it. The study surveyed gonorrhea bacterial isolates—Neisseria gonorrhoeae—from around the country and found that the prevalence of ceftriaxone-resistant isolates nearly tripled between 2017 and 2021. Ceftriaxone-resistant strains made up roughly 8 percent of the nearly 3,000 bacterial isolates collected from gonorrhea infections in 2022. That’s up from just under 3 percent in 2017. The study appears in the CDC’s Morbidity and Mortality Weekly Report.

While those single-digit percentages may seem low, compared to other countries they’re extremely high. In the US, for instance, the prevalence of ceftriaxone-resistant strains never went above 0.2 percent between 2017 and 2021, according to the CDC. In Canada, ceftriaxone-resistance was stable at 0.6 percent between 2017 and 2021. The United Kingdom had a prevalence of 0.21 percent in 2022.

Ceftriaxone is currently the first-line treatment for gonorrhea because Neisseria gonorrhoeae has spent the past several decades building up resistance to pretty much everything else. As the CDC notes, in the 1980s, the drugs of choice for gonorrhea infections were penicillin and tetracycline. But the bacteria developed resistance. By the 1990s, the CDC was forced to switch to a class of antibiotics called fluoroquinolones, including ciprofloxacin (Cipro). But fluoroquinolone-resistance developed, too, and resistance to Cipro is now widespread. In the early 2000s, the CDC began having to tweak the recommendations as resistance spread to new places and populations.

Resistance rising

By 2007, the agency switched to cephalosporins, including cefixime. In 2010, the CDC updated the treatment again, recommending that doctors combine cephalosporins with one of two other types of antibiotics—azithromycin or doxycycline—to try to thwart the development of resistance. But, it also was no use. Two years later, in 2012, the CDC updated recommendations when cefixime resistance developed. In 2020, azithromycin was also abandoned. The cephalosporin ceftriaxone is the last drug standing in the US to treat gonorrhea infections.

Resistance of gonococcal isolates to ciprofloxacin, penicillin, tetracycline, azithromycin, cefixime, ceftriaxone, and spectinomycin—13 Gonococcal Resistance Surveillance Program sentinel sites, China, 2022.

Enlarge / Resistance of gonococcal isolates to ciprofloxacin, penicillin, tetracycline, azithromycin, cefixime, ceftriaxone, and spectinomycin—13 Gonococcal Resistance Surveillance Program sentinel sites, China, 2022.

In China, the swift spread of ceftriaxone-resistance isolates is alarming. The data stems from 2,804 isolates, representing 2.9 percent of all cases reported in China during 2022. Those figures come from 13 of the country’s 19 provinces. While the overall prevalence of ceftriaxone-resistance isolates was 8.1 percent among the 2,804 isolates, five of those 13 provinces had prevalence rates above 10 percent. Three provinces had prevalence rates above 25 percent. In all, 18 isolates were resistant to all the antibiotics tested except for a bygone antibiotic called spectinomycin, which is discontinued in the US and elsewhere.

The study has limitations. For one, the reported number of gonorrhea cases are very likely an undercount of actual cases. Beyond gaps in reporting, many people with gonorrhea have no symptoms and, as such, don’t seek treatment. Additionally, the isolates the researchers did have represented less than 3 percent of reported cases, so it’s possible the prevalence rates don’t represent the isolates of the entire country. Also, the researchers didn’t have detailed case data that might help identify specific risk factors for resistance development, such as the antibiotic treatments patients had. The authors did note that antibiotics are only given by prescription in China.

“These findings underscore the urgent need for a comprehensive approach to address antibiotic-resistant N. gonorrhoeae in China, including identifying factors contributing to this high resistance rate, especially in provinces where the percentage of gonococcal isolates resistant to ceftriaxone is >10 percent,” the authors write.

But they also note that this is not just an alarming finding for China but also a “pressing public health concern” for the entire world. “These resistant clones have spread internationally, and collaborative cross-border efforts will be essential to monitoring and mitigating its further spread,” they write.

China has a big problem with super gonorrhea, study finds Read More »

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More than half of chickenpox diagnoses are wrong, study finds

CDC, chickenpox, diagnostic, laboratory testing, Science, symptoms / /

coin flip —

Vaccination has dramatically reduced cases, making clinical diagnoses tricky.

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Chickenpox on a 1-year-old.

Enlarge / Chickenpox on a 1-year-old.

Thanks to the vaccination program that began in 1995, chickenpox is now relatively rare. Cases of the miserable, itchy condition have fallen more than 97 percent. But, while children have largely put the oatmeal baths and oven mitts behind them, doctors have apparently let their diagnostic skills get a little crusty.

According to a study published Thursday, public health researchers in Minnesota found that 55 percent of people diagnosed with chickenpox based on their symptoms were actually negative for the varicella-zoster virus, the virus that causes chickenpox. The study noted that the people were all diagnosed in person by health care providers in medical facilities. But, instead of chickenpox, lab testing showed that some of the patients were actually infected with an enterovirus, which can cause a rash, or the herpes simplex virus 1, which causes cold sores.

The study, published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, supports expanding laboratory testing for suspected chickenpox cases in the state’s program and highlights that diagnoses based on symptoms are “unreliable.”

For one thing, doctors simply see far fewer chickenpox cases these days because of the protection from vaccines. While chickenpox cases in the US previously reached 4 million each year, with 10,500 to 13,500 hospitalizations and 100 to 150 deaths, there are now fewer than 150,000 cases,1,400 hospitalizations, and 30 deaths each year, the CDC reports. Vaccination is more than 90 percent effective at preventing the disease. In the rare cases where a vaccinated person contracts chickenpox, the muted rashes are challenging to identify by eye. But even in unvaccinated children, chickenpox can be tricky to pick out; it can easily be confused with measles, insect bites, enterovirus, skin infections such as scabies and impetigo, herpes viruses, and hand, foot, and mouth disease.

Since 2016, the Minnesota Department of Health has been working to expand laboratory testing, including outreach to health care providers and the public on the importance of testing to confirm suspected chickenpox cases.

Between 2016 and 2023, 208 people who were diagnosed with chickenpox in person at a medical facility submitted specimens for testing to the state health department. Only 93 of the 208 (45 percent) were positive for the virus. The vaccination status was known for 203 of the people—100 were vaccinated, 103 were not. Of the vaccinated people tested, only 22 (22 percent) turned out to have chickenpox, while 68 (66 percent) of the unvaccinated people had it, reflecting the efficacy of vaccination.

In a larger group of 420 people, which included people who were self-diagnosed, the accuracy rate was unsurprisingly lower. Of the 420 suspected chickenpox cases, only 157 (37 percent) were positive for the varicella-zoster virus. Of the remaining 263 people, 47 were positive for enterovirus, 20 were positive for herpes simplex virus 1, 0 were positive for herpes simplex virus 2 (genital herpes), two people had indeterminate test results, and 194 were negative for all four viruses tested.

The authors highlight that the findings are significant because people suspected of having chickenpox are recommended to stay home from school and work longer than people with other viral infections. More testing can ensure appropriate clinical management.

More than half of chickenpox diagnoses are wrong, study finds Read More »

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Health experts plead for unvaxxed Americans to get measles shot as cases rise

American Medical Association, CDC, children, health, health advisory, infectious diseases, measles, Science, travel, vaccination, vaccines / /

MMR is safe and effective —

The US hit last year’s total in under 12 weeks, suggesting we’re in for a bad time.

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A view from a hospital as children receiving medical treatment, in capital Kabul, Afghanistan on April 18, 2022. More than 130 children have died from the measles in Afghanistan since the beginning of this year.

Enlarge / A view from a hospital as children receiving medical treatment, in capital Kabul, Afghanistan on April 18, 2022. More than 130 children have died from the measles in Afghanistan since the beginning of this year.

The Centers for Disease Control and Prevention and the American Medical Association sent out separate but similar pleas on Monday for unvaccinated Americans to get vaccinated against the extremely contagious measles virus as vaccination rates have slipped, cases are rising globally and nationally, and the spring-break travel period is beginning.

In the first 12 weeks of 2024, US measles cases have already matched and likely exceeded the case total for all of 2023. According to the CDC, there were 58 measles cases reported from 17 states as of March 14. But media tallies indicate there have been more cases since then, with at least 60 cases now in total, according to CBS News. In 2023, there were 58 cases in 20 states.

“As evident from the confirmed measles cases reported in 17 states so far this year, when individuals are not immunized as a matter of personal preference or misinformation, they put themselves and others at risk of disease—including children too young to be vaccinated, cancer patients, and other immunocompromised people,” AMA President Jesse Ehrenfeld said in a statement urging vaccination Monday.

The latest data indicates that vaccination rates among US kindergarteners have slipped to 93 percent nationally, below the 95 percent target to prevent the spread of the disease. And vaccine exemptions for non-medical reasons have reached an all-time high.

The CDC released a health advisory on Monday also urging measles vaccination. The CDC drove home the point that unvaccinated Americans are largely responsible for importing the virus, and pockets of unvaccinated children in local communities spread it once it’s here. The 58 measles infections that have been reported to the agency so far include cases from seven outbreaks in seven states. Most of the cases are in vaccine-eligible children aged 12 months and older who are unvaccinated. Of the 58 cases, 54 (93 percent) are linked to international travel, and most measles importations are by unvaccinated US residents who travel abroad and bring measles home with them, the CDC flagged.

The situation is likely to worsen as Americans begin spring travel, the CDC suggested. “Many countries, including travel destinations such as Austria, the Philippines, Romania, and the United Kingdom, are experiencing measles outbreaks,” the CDC said. “To prevent measles infection and reduce the risk of community transmission from importation, all US residents traveling internationally, regardless of destination, should be current on their [measles-mumps-rubella (MMR)] vaccinations.” The agency added in a recommendation to parents that “even if not traveling, ensure that children receive all recommended doses of MMR vaccine. Two doses of MMR vaccine provide better protection (97 percent) against measles than one dose (93 percent). Getting MMR vaccine is much safer than getting measles, mumps, or rubella.”

For Americans who are already vaccinated and communities with high vaccination coverage, the risk is low, the CDC noted. “However, pockets of low coverage leave some communities at higher risk for outbreaks.” This, in turn, threatens wider, continuous spread that could overturn the country’s status of having eliminated measles, which was declared in 2000. The US was close to losing its elimination status in 2019 when outbreaks among unvaccinated children drove 1,247 cases across 31 states. Vaccination rates have only fallen since then.

“The reduction in measles vaccination threatens to erase many years of progress as this previously eliminated vaccine-preventable disease returns,” the AMA’s Ehrenfeld warned.

As Ars has reported previously, measles is among the most contagious viruses known and can linger in airspace for up to two hours. Up to 90 percent of unvaccinated people exposed will contract it. Symptoms can include high fever, runny nose, red and watery eyes, and a cough, as well as the hallmark rash. About 1 in 5 unvaccinated people with measles are hospitalized, while 1 in 20 infected children develop pneumonia, and up to 3 in 1,000 children die of the infection. Brain swelling (encephalitis) can occur in 1 in 1,000 children, which can lead to hearing loss and intellectual disabilities. The virus can also destroy immune responses to previous infections—a phenomenon known as “immune amnesia”—which can leave children vulnerable to various other infections for years afterward.

Health experts plead for unvaxxed Americans to get measles shot as cases rise Read More »