infectious disease

Zika fever in Brazil

November 15, 2018 / global health, Latin America / , , , , ,
"Rash on Arm due to Zika virus," uploaded to Wikipedia by FRED on January 10, 2014. See https://commons.wikimedia.org/wiki/File:Zika.Virus.Rash.Arm.2014.jpg
“Rash on Arm due to Zika virus,” uploaded to Wikipedia by FRED on January 10, 2014. See https://commons.wikimedia.org/wiki/File:Zika.Virus.Rash.Arm.2014.jpg

The health news from Brazil is truly remarkable, as the Ministry of Health is advising women in the northeast not to become pregnant at this time because of the emergence of a new disease in the Americas called Zika fever. Historically, Zika fever has been a very rare disease, which until 2007 had caused only a small number of diagnosed cases in Africa and Asia. The Zika virus was native to the forest of Zika in Uganda, where it circulated amongst monkeys. The disease suddenly appeared in 2007 in Micronesia, then spread to French Polynesia in 2013, followed by Easter Island in 2014, before finally arriving in Brazil. The disease causes many of the same symptoms as dengue (high fever, headache, joint and muscle pain, nausea, stomach pain, exhaustion, pain in the back of the eyes, conjunctivitis, a maculopapular rash, and swelling of the legs). This is unsurprising because dengue and the Zika virus are members of the same viral family (flaviviridae), and are both spread by the same species of mosquitoes, particularly Aedes aegypti and Aedes albopictus. There is no treatment or vaccine for Zika fever.

When it first appeared in Bahia, in northeastern Brazil, in April 2013, it was not immediately obvious that this was a new disease. As patients were tested for dengue, however, and the results came back negative, the medical system soon realized that something unusual was happening. While worrying, the disease did not seem disastrous when it appeared in Brazil. People can be infected with Zika fever only once. The symptoms typically last four to seven days, then the patients recovers. In some cases, patients suffer from immunological or neurological disease (Guillain-Barre syndrome) as a result of their infection, but this is atypical. When it appeared, the disease seemed to be less serious than dengue. Very few people have died from it in Brazil. As the epidemic continued, however, doctors began to report a bizarre increase in the number of babies born with a serious birth defect, microcephaly. This disorder is characterized by a reduction in the size of the head of the baby. The rate of this disorder has increased sharply, perhaps ten-fold over the last year. Some doctors at Brazil’s Hospital Oswaldo Cruz are now suggesting that the problem is unrelated to Zika fever, but rather is tied to another emerging infectious disease in the region, Chikungunya. …

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MERS in South Korea

June 12, 2015 / Asia, global health / , , ,
Photo of Korea from space by NASA, and obtained from the CIA World Factbook.
Photo of Korea from space by NASA, and obtained from the CIA World Factbook.

I have blogged about MERS before on this site, but this disease has faded from the news for the last year, until the most recent outbreak in South Korea. Middle East Respiratory Syndrome is an infectious disease caused by a corona virus, in the same manner as the SARS outbreak of 2003. The disease first appeared in Saudi Arabia in 2012, and has continued to circulate there since. In Saudi Arabia the virus has seemed to spread particularly well in a health care setting. While a number of infected people –many of whom have been health care professionals- have carried the virus to other countries, in every case the outbreak has been contained. The outbreak in Korea has been different because of its scale –eleven people have died and over three thousand have been quarantined- and speed.

South Korean citizens have criticized the government for responding too slowly to the outbreak. One person, for example, broke voluntary quarantine and traveled to China, where he ultimately fell ill. There is no question, however, that South Korea is now taking the outbreak seriously. Over 1,800 schools and daycares are closed, even though the World Health Organization (WHO) says that this measure is unnecessary. An entire small Korean village (approximate population 130) has been placed under quarantine with guards manning checkpoints. The authorities are tracking peoples’ cellphone location to make sure that they are remaining in quarantine, and health authorities are checking on people at their homes. At the time of this writing, it seems as though MERS may have peaked in South Korea, and hopefully will soon begin to fade. …

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Conspiracy theories and the 2009 influenza pandemic

March 26, 2019 / global health, Theory / , , , ,

The Journal of International and Global Studies is an open access journal, which has just published my article: Whom do you trust: Doubt and Conspiracy theories in the 2009 Influenza Pandemic. The article examines how people in widely separated world regions responded to the pandemic with motifs based around trust and betrayal. While the article focuses on influenza, it also discusses other diseases such as polio and Ebola. Currently the Ebola in West Africa has been waning, and Liberia has finally been declared to be free of the disease. Even now, however, public health workers have to struggle against a powerful narrative of denial, which depicts Ebola as a tool created by the West to sell expensive medications. As I discuss in the article, such narratives have deep roots.

Shawn Smallman

Randall Munroe, XKCD Creative Commons Attribution and non-commercial use 2.5 license

Bird Flu in the United States

June 10, 2015 / global health / , ,

As Americans and Canadians follow the threats posed by emerging infectious diseases they are accustomed to hearing news from distant countries such as Saudi Arabia or Liberia. While the threat posed by highly pathogenic avian influenza (HPAI) may move its focus from Indonesia to Egypt, events seem far from our borders. Yet the U.S. is now in the midst of a grave outbreak of HPAI, which is devastating flocks in the Midwest. While this is primarily an avian disease, there is always the risk that it may jump to humans. Even if it remains confined to poultry, the long-term economic effects are serious. The virus is unlikely to disappear or be eradicated at any time in the near future. As always, Maryn McKenna is one of the best observers of issues related to infectious disease. I highly recommend her recent article on this topic here. It’s important to note that there is no evidence that the virus is transmitting from birds to humans at the current time, and that the CDC is preparing a vaccine, just in case. As others have noted, the larger issue is the sheer number of HPAI strains circulating globally, which is very different from even a decade ago.

Update: one of the students in my “Introduction to International Studies” class recommended this article in Time. You can also see my most recent article on conspiracy theories and the 2009 influenza pandemic for free.

Shawn Smallman, Portland State University

The AIDS Pandemic in Latin America

April 19, 2015 / global health, Latin America / , , ,

This week I had a chance to have a discussion via Skype with a class in Ithaca, New York, which had read my book on the AIDS Pandemic in Latin America. The class asked what had changed with the epidemic since I wrote my book, as well as what would I change if I were to write it now? The good news is that there has been a great deal of progress in the fight against HIV in the region. More people are receiving appropriate therapy, fewer babies are being born with HIV, and the rate of condom use is up in many nations. At the same time, the number of people living with HIV is slowly increasing, in part because people are now living longer with the infection, thanks to better therapy. …

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Ancient Medicines

April 7, 2015 / global health / , ,
Bayeux Tapestry Scene 44, taken from Wikipedia Commons at https://commons.wikimedia.org/wiki/File:Bayeux_Tapestry_scene44_William_Odo_Robert.jpg
Bayeux Tapestry Scene 44, taken from Wikipedia Commons

Over the last ten years there has been a lot of discussion about the post-antiobiotic era, as increasing numbers of drugs lose their efficacy. One of the key problems has been the practice of using antibiotics as a growth enhancer in agriculture. Recently, researchers at Texas Tech discovered that antibiotic resistant bacteria from feedlots are airborne. Now there may be a new alternative to addressing antiobiotic resistance discovered in England, where researchers at the University of Nottingham tested a recipe to treat infections from the 9th century. There cannot be too many medical researchers willing to work with directions that have to be translated from early Anglo-Saxon. If you’re curious, you can click here to see the strengths of a medieval approach to the problem of infection. What the researchers found was that a recipe based on cow bile, garlic and wine successfully killed MRSA in the lab, even when it had developed biofilms, which make it difficult to treat. Of course, this study took place in testtubes and mice rather than in a clinical setting. It will be some time before we know if these results can be replicated in people. Still, it raises the point that the modern age does not have a monopoly on medical knowledge.

When Chinese scientists needed to find a treatment for drug-resistant malaria during the Vietnam War, they turned to sweet wormwood, which was an age-old treatment found in classic Chinese medical texts. It soon became the standard treatment for malaria, although resistance is again emerging in South East Asia. Who knows what other remedies may be hidden in old formularies that have not been used in centuries, not only in Europe, but also in many other nations?

Shawn Smallman, Portland State University

Online “course” about Ebola

April 2, 2015 / global health / , ,

Two outstanding journalists in the area of infectious disease, Helen Branswell of Canada Press and Martin Enserink with Science, have teamed up to create an online “course” on Ebola.  Although it was designed (with support from the U.S. Department of State) to help journalists preparing to cover Ebola, the website will give anyone a good introduction to basic facts about the disease. Another good source for information is the CDC Ebola website, for more in depth coverage.

Shawn Smallman, Portland State University

David Quammen’s The Chimp and the River

April 19, 2015 / global health / , ,
Mercator Map of the Congo, 1595, from the Northwestern University Library Maps of Africa collection, accessed through Wikipedia.
Mercator Map of the Congo, 1595, from the Northwestern University Library Maps of Africa collection, accessed through Wikipedia.

I have done work for much of the last 15 years in global health, and wrote a book about the AIDS Pandemic in Latin America. I’ve returned to thinking about HIV recently because I’ve just given a lecture on the Global AIDS pandemic, during which I discussed media coverage of not only the new gene therapy to fight HIV, but also the discovery of an HIV strain in Cuba that seems to lead to AIDS more rapidly than is typical. Behind these news stories remains the fact that over 35 million people are now living with HIV. It is true that impressive advances in both medicine and public health now mean that there is more hope concerning the epidemic than at any time before. Still, despite the merited attention given to the Ebola outbreak in West Africa, it’s worth remembering that over a million people died of AIDS last year, far more than all the Ebola outbreaks in recorded history combined. How did this outbreak begin? Since I first began to study the virus a great deal has been learned about its evolutionary history, and the circuitous path that the virus took from an unknown individual in Cameroon to become a global pandemic. …

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NPR’s “Life after Death.”

April 19, 2015 / Africa, global health / , , ,

I know that people may be tired of hearing about Ebola, which is a painful topic. Still, I have to strongly recommend a new storyboard by NPR reporters called “Life after Death,” which describes one village’s experience with the outbreak. The storyboard combines audio interviews and stunning photographs to create an account that is moving, informative and beautiful. It illustrates the the human reaction to the outbreak, and the toll that the disease continues to take from the community after people stop dying. I think that this storyboard shows the potential of new media, which combine the content of text-based journalism, with the artistic expression of photo-journalism. One alert- if you are viewing this at work, you probably should put on your headphones before you click on the link above.

If you are interested in global health, you can find my book on the AIDS Pandemic in Latin America here.

Shawn Smallman, Portland State University

Influenza and Respect

June 10, 2015 / global health / , , , ,

The French website Sentiweb tracks disease prevalence in the country. This winter the map of influenza-like illness in France has been a sea of red, which documents a particularly bad year. The situation in Germany is no better. Influenza viruses mutate over time, which means that every year vaccine makers must guess which strain of the virus is most likely to cause illness in the coming season. Sadly, this year’s vaccine was poorly matched with the strain of H3N2 that has caused the most illness. According to a study in the U.S. it was only 23% effective, while one study in Canada found that people were actually more likely to become ill if they had been vaccinated. You can’t have a much worse vaccine that that. This situation has meant that more people in the United States went to the hospital with an influenza-like illness than in most years, particularly amongst the elderly. At least in the United States the influenza season is now waning. In my home state of Oregon, influenza cases peaked last month. This sadly does not seem to be the case in France as this map suggests. As in the United States, the majority of cases in France have been the H3N2 strain.

People tend not to treat influenza with sufficient respect. Years ago I had a phone call from someone who wanted to drive to Portland to meet me in my role as the Director of International Studies. The morning of the meeting I woke up and knew right away that I had the flu.  It felt as though somebody had turned up the gravity in my room. I had a high fever and could barely stand. But not wanting to disappoint them, I dragged myself to the office. They didn’t show up, and after an hour I went home. I consoled myself that it was for the best, because they last thing that they needed was to catch my flu. …

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