waterspyder | Catching up

Catching up

Okay, so I'm catching up on this hurricane deal.

theweaselking posted an awesome newsclip you can see here.

panthertriad on the other hand linked to a jounral post http://thememoryblog.org/archives/000588.html, and while some of this is a little exagerrated, as in Ebola and Marburg are not level 3 contagions, they are level 4 and thus would not be located at these facilities (in theory), the premise is still frightening. I was personally concerned about outbreaks of cholera, maybe typhoid since they are common in this sort of situation, but now it could be that release of a variety of pox and flus would also be a legitimate concern. The probability is low that an outbreak would happen, but I can certainly also see why the evacuation of people from the affected areas, willing or not, would be a little more pressing that just "death by dysentery". Also http://www.cdc.gov/od/sap/index.htm.

Quick Primer of Biosafety

Biosafety Level 1
Basically these are things that are difficult to catch as defined by how it is spread (airborne is more contagious than by touch), and are not life threatening. Many of these things can not even be contracted by humans. Think E.Coli infection or low level bacterial or yeast infections.

Biosafety Level 2
These are things that are easier to acquire (bloodborne or by touch, longer persistence in the environment), and while they are generally not life threatening, they can cause serious complications. There is immunization or antibiotic treatments available for each of the items in this category. This is where salmonella, chicken pox, Hepatitis B and measles reside. Not enjoyable, but won't kill you.

Biosafety Level 3
I'll be honest, this can still be scary despite not being the highest level. All of these pathogens can be lethal, but take a little effort to catch and are mainly bloodborne. This includes things like HIV, encephalitis and tuberculosis.

Biosafety Level 4
These are scary, and as such are only housed in 5 reported facilities in the world. These are all typically airborne, highly infectious and deadly. This includes Ebola and Marburg.

I think I need to not read anymore for now. *The part of my brain trained in epidemiology shivers*

Flat | Top-Level Comments Only

Mousepox! Oh dear god there was MousePox!

That requires mice to have not drowned in order to be infected and then spread it.

This could all be avoided if we were all immunized against smallpox.

OTOH, if smallpox immunization isn't recommended for (about halfway down the page) (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;110/4/841) "people with eczema or other exfoliative skin disorders, for pregnant women, or for people with immunodeficiencies", and they cite an article saying roughly 15% of the population suffers from eczema (and that said people may be susceptible to eczema vaccinatum complications even if their skin disorder is in remission), and since there isn't enough vaccine to treat everyone, and I imagine there would be difficulty treating everyone who had adverse reactions, and since post-exposure vaccination can develop your immunity before the incubation period is up, and since there are nastier and more effective diseases that can be used anyway, I can see the arguments for not immunizing everybody against smallpox.

(...I just realized you and I know at *least* three people who are on the "immunization not recommended" list.)

Smallpox is just a scary premise. Theoretically it is gone, except that two cultures of smallpox were maintained (paranoia and all), one in the United States, and one in the former Soviet Union. Neither of these vials makes me comfortable. I don't trust the current US not to develop biological weapons with it, and I don't trust that the former Soviet Union didn't sell it to say... South Korea? in times of economic hardship. I pick on South Korea since it was discovered in 2002 that the entirety of their military was immunized against smallpox, as was much of their population. Ongoing scientific research my ass (in regards to all mentioned).

Smallpox is also a little bit scandalous. To immunize humans against smallpox means we are also immunized against a variety of other pox conditions, one of these is monkeypox. Now during the worldwide immunizations from 1958 to 1979 that cost $300 million USD that resulted in a successful herd immunity (this is rarely accomplished successfully), the World Health Organization reached Africa and found that they did not have widespread smallpox and so did not immunize most of Africa. Africa's underdeveloped nature actually assisted them in avoiding widespread outbrealks. What is sad about this is that much of Africa was being afflicted with related conditions like monkeypox, and the WHO decided not to continue immunization protocols since smallpox was their target, and it was other pox viruses in third world countries still existed. When I learned about this in 1998, I was immediately concerned that the short-sightedness, paired with what could be interpreted as a socioeconomic and/or racial bias, would result in outbreaks in other regions of the world. It is impossible to consider Africa a seperate continent in the viral sense. In 2003 my concerns became real as outbreaks of Monkeypox occurred in the United States. Yes, it took 30 years (though only 6 years after my supposition), but that doesn't make my paranoid-sounding essays any less accurate.

http://en.wikipedia.org/wiki/Monkeypox
http://en.wikipedia.org/wiki/Smallpox

My recommendation to immunize everyone is entirely based on my particular level of paranoia of biological warfare and global community on that day.

ObQuibble: the smallpox vaccine helps against monkeypox, but does not immunize you--it's only got something like 85% effectiveness.

I understand the distrusting reaction, but I do not think you need to be operating with a bias to conclude that, when 40 people per million have life-threatening reactions and you don't need to put them at risk of that to get rid of the specific disease you're targeting, perhaps you should not put them at risk. (Operating with the narrow focus on a goal often found in bureaucracy, yes. That's different, dammit.)

In an ideal world, where you could care for everyone who had a bad reaction (given the nearly 40 million people who had HIV in 2004, I do not even want to think about the possible complications), and where vaccination would cover every recombinant and resistant strain that could be developed, I can see the value of immunization against a disease that you can successfully be innoculated against after exposure.

Right now, not so much.

I can't really argue with you. Monkeypox is only one example of the 20 or so viruses that smallpox also provides protection against, all almost exclusively found in Africa like camelpox or taterapox. Some are still found in north america, like cowpox, which produces a negligible infection in humans. In an era where planes are so common, I understand how small the global community is. I don't mean to freak people out, but knowing there is a way to protect people from several deadly and/or disfiguring strains of pox viruses, it kind of concerns me that we don't, or that we don't try and develop a vaccine that is not so dangerous to use. I think sometimes we are as a society a little too reactive. I usually keep many of my opinions to myself since otherwise I look like that crazy person on the side of the road with the sign "The End is Near". I don't think the end is near, I just think we should start being a little smarter about things as a society. Mumps, dyptheria, pertussis and polio are making a comeback since people don't remember the detrimental effects of these diseases and think vaccines are a bunch of hooey. Yes, there are risks to being immunized, and I don't urge people who are at risk to get immunized, but I think that people who are healthy should get immunized against these conditions to protect those who cannot be immunized and to protect themselves. Influenza is a classic case, no one remembers how devastating influenza can be. Now there is a vaccine, and yes, the researchers have to guess a year in advance which strain will come through. The good news is the more you are immunized every year, the more you are protected against strains you have not been directly immunized against just due to shared properties of the immunizations. Even if you do contract influenza, typically the duration and the severity of the illness is greatly lessened. People forget that this is an infection that kills. I do however not support the live virus nasal spray out of paranoia, go for dead virus injection.

I admit I get a little wonky only because the worst case (and also very possible) scenario runs through my brain periodically. I'll admit that the chain of events that would have to occur as a result of Katrina to release these pathogens is pretty slim, once the correct sequence of events occur, the rest would blow up pretty disproportionately in that situation.

Also a note on herd immunity: if all the people who can safely get immunized, do get immunized, then those 40 per million should actually be just as good as immunized barring sheer bad luck.

> In an era where planes are so common, I understand how small the global
> community is. I don't mean to freak people out, but knowing there is a way
> to protect people from several deadly and/or disfiguring strains of pox
> viruses, it kind of concerns me that we don't, or that we don't try and
> develop a vaccine that is not so dangerous to use.

A vaccine that isn't so dangerous would be handy; OTOH, I can

Too many problems, not enough resources.

> I think sometimes we are as a society a little too reactive. I usually
> keep many of my opinions to myself since otherwise I look like that crazy
> person on the side of the road with the sign "The End is Near".

I promise not to put you in my mental crazy file. Not over this, at any rate.

> I don't think the end is near, I just think we should start being a little
> smarter about things as a society. Mumps, dyptheria, pertussis and polio'
> are making a comeback since people don't remember the detrimental effects
> of these diseases and think vaccines are a bunch of hooey.

To be fair, I cannot comment on this; I don't know anyone who slacks badly enough to not bother vaccinating. (Possibly more accurately: I don't know anyone who's admitted to slacking badly enough etc.)

> Yes, there are risks to being immunized, and I don't urge people who are
> at risk to get immunized, but I think that people who are healthy should
> get immunized against these conditions to protect those who cannot be
> immunized and to protect themselves.

I agree; the trouble is that in a few cases, the vaccination is dangerous enough that it's recommended you avoid it unless you've been exposed.

> Also a note on herd immunity: if all the people who can safely get
> immunized, do get immunized, then those 40 per million should actually be
> just as good as immunized barring sheer bad luck.

I think I was unclear. Those 40 million aren't just people who should avoid immunization unless they're exposed. Those are people who shouldn't even be living with someone who's been immunized (http://www.bt.cdc.gov/agent/smallpox/vaccination/contraindications-public.asp).

And that 40 million was just HIV. Add in people who have eczema, it's 130 million. Also anyone who doesn't have either condition but currently has a weakened immune system for any other reason, burns, chickenpox, shingles, impetigo, herpes, severe acne, psoriasis, or is pregnant--where are you going to store two percent of the world's population until it's safe for them to associate with the immunized people again? Some of them will already be in hospitals, yes, and some of them won't be living with anyone. That's why it's only 2%.

(Heh. Time for a vaccine against the vaccine.)

I didn't realize that they couldn't be exposed to people who had received the immunization. Do you by any chance have a website/jounarnal article so I can read into this a little more. I had never had that scenario presented to me in school or in my research. I can see how for about 5 days post-innoculation that exposure to people with immune deficiencies/susceptibilities or existing viral conditions may pose a risk, but I would still like to read up on it.

I did misunderstand the 40 million number, and misread it as another statistic.

As for mumps, I *personally* know 37 people who developed mumps through failure to vaccinate. I hear reported cases of the other conditions I mentioned since it is of concern for the WHO and the CDC. I can understand resistence to new varicella (chickenpox) vaccines since the vast majority of children suffer no lasting effects from chicken pox, but the DPT (diphtheria, polio, tetanus) and the MMR (Measles, Mumps, Rubella) were very widespread and damaging infections. Death, blindess and nervous system damage were not uncommon. I think it will be a long time before vaccines stop being controversial.

Fortunately, post-exposure inoculations are available for pox viruses, though they are not in high production. That would also require that France was not suffering any sort of outbreak for us to get those vaccines. I am eternally grately for that high school teacher who made it very clear to us that while it is unfortunate, science, medicine and politics are not independant of teach other.

("But one of the side effects is death, but I have a pill to cure that too." -from Foamy)

I'm going pretty much off the CDC's section on smallpox (http://www.bt.cdc.gov/agent/smallpox/index.asp). The American Academy of Pediatrics also has a page (http://aappolicy.aappublications.org/cgi/content/full/pediatrics;110/4/841) on it. Health Canada has a Q&A (http://www.phac-aspc.gc.ca/ep-mu/smallpox_e.html) and an outline of emergency response (http://www.phac-aspc.gc.ca/media/issues/smallpox_e.html) on their page, but not much else; to be honest, teh CDC seems to have more information (form example, specifying the four different types and their mortality rates).

I believe the US currently has enough vaccine to provide post-exposure innoculation to the entire population--if you get the vaccine within three days after exposure, you can develop an immunity from it before the damn stuff finishes incubating, and even four to seven days after exposure it still helps. Health Canada's page says they're working on adding ten million doses to their supply, but doesn't give a solid record of how close they are to it; they started working on that in 2003.

(Apologies on the earlier figures, I was off by a decimal point. Atopic dermatitis affects 15% of the population (off the AAP page), world population is 6446 million, minus the 40 for HIV gives you 6406, times 0.15 gives you 960.9, round down because I'm an optimist, add the 40 back in...

Based off HIV and atopic dermatitis alone, that's a billion people who shouldn't be living with someone who's been vaccinated against smallpox. My bad.)

eek. 1 billion out of 6.5 billion?
I'm sure there probably still several billion people immunized (I was born within 5 years of the cessation of routine immunization and both my parents are immunized, as are my grandparents... in theory I probably should not have been living with them).

Canada is indeed working on getting enough doses and I was under the impression they were close to that goal. Unless something has changed in 3 years though, that supply is being stored in France where the vaccine is produced since Canada presently (as of 2002) does not have the facilities to produce the smallpox vaccine or store it for any length of time. I hope someone has changed this practice/remedied this situation because I don't doubt France would use the stock to vaccinate its own populace before turning it over to us. I mean, wouldn't you try to protect your own people first?

Scary, but with luck we'll never have to find out.

Children younger than a year shouldn't get vaccinated, but there's no problem with them living with someone who did.

365,000 doses of the vaccine are stored in Canada, and they're loking at the possibility of dilution (according to the AAP page, 2001 studies show that the vaccine seemed to remain effective at at least 1:5 dilution, and possibly 1:10; the CDC doesn't give proportions, but does say that diluted doses are just as effective).

Also, in January, the WHO started doubling its smallpox vaccine stock to 5 million.

And yes, I would try to protect my own people. But France was confident enough to give away 85 million doses of the stuff in 2002, so I'm guessing (I can't find stats on this, unfortunately) they feel they have enough for their own use.

On a more practical note, I would not innoculate my entire population because smallpox hit elsewhere, or even because smallpox hit one segment of my population. I realize it's a lot easier for diseases to travel, but it's not like an individual who's infectious is as unnoticeable as someone with a cold; you're either on your back with a 101-104'F fever and possibly vomiting (and not even guaranteed to be infectious by then), or you've started bursting with pus and lesions.

If all of France was exposed to the virus by aerosol or some other means, and no-one realized until people started getting sick, then yes, I'd innoculate everyone.

Theproblem is tit has an incubation period that allows it to travel and roam. Ebola doesn't scare me as much since a person will be dead before stepping off the flight. Five day incubation is plenty of time to get on a plane and hop continents.

We probably debating this into the ground at this point.
It's freaky, there's no clear answer.

> Theproblem is tit has an incubation period that allows it to travel and roam.

It does. On the plus side, if it's contagious you're obvious to very obvious, and it's not likely to be mistaken for anything else.

> Ebola doesn't scare me as much since a person will be dead before stepping
> off the flight. Five day incubation is plenty of time to get on a plane
> and hop continents.

Ebola's incubation period is 2 to 21 days--longer than smallpox--and the only references I can find to how long it takes to die say things like "the fifth day of illness (http://www3.baylor.edu/~Charles_Kemp/ebola.htm)", "begin to recover after 7 to 10 days (http://tarakharper.com/v_ebola.htm)", and "8 to 10 days, but may be up to two weeks (http://en.wikipedia.org/wiki/Ebola#Fiction)". The specific discussion of a 1976 outbreak (http://www.itg.be/ebola/ebola-12.htm) mentions patients dying on day 7 and 8 after admission.

> We probably debating this into the ground at this point.

Probably. Also, it's worth remembering all those recommendations about vaccination not being worth it are based on smallpox no longer existing outside of labs. If that changes, so do the recs.

Well, it depends on the typpe of Ebola. Uber-scary ebola incubates and kills quickly with a 95% mortality. Kinder, friendlier Ebola incubates longer and has a 25% mortality rate.

I would rather not catch either one in any case.

> Well, it depends on the typpe of Ebola. Uber-scary ebola incubates and
> kills quickly with a 95% mortality. Kinder, friendlier Ebola incubates
> longer and has a 25% mortality rate.

Adding up the figures on cases and deaths from the WHO website gives Ebola-Zaire an 81% mortality rate (a couple of sites say 90% - Wikipedia and what looks like a student page at Stanford), Ebola-Sudan a 53% mortality rate, and Ebola-Côte d'Ivoire (all two cases) a 0% mortality rate. Ebola-Reston has never caused illness in humans, although four people developed antibodies.

Can't find anything on the incubation periods for either; if you have a reference I'd be grateful.

> I would rather not catch either one in any case.

Agreed.

Hmm, I wonder if those rates have changed...

I did a research project on it in 1999, though it is possible these numbers have changed based upon scientific review and/or further outbreaks. Speaking of outbreaks, apparently Marburg virus is currently an epidemic in Angola
http://www.who.int/mediacentre/factsheets/fs_marburg/en/index.html
I wonder if I was thinking of Marburg and Ebola...
this one has an update of the Marburg outbreaks...
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/marburg/marburgtable.htm

Other Ebola sites.
http://www.cdc.gov/mmwr/preview/mmwrhtml/00037078.htm
http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/ebola.htm

I also looked at the conditions for the close contact. It was not 5 or 6 days as I presumed, it was 30 or so days. Basically if someone has been immunized in the past it's no big deal, but if you have those conditions (many of which are temporary like impetego and poison ivy) then the person you live with or have intimate relations with should not get the vaccine. IE, if zenten wanted to get vaccinated, then he should find somewhere else to stay for a month. Of course I'm paranoid, so I'd probably just make him wait until I had the immunization done myself.

Flat | Top-Level Comments Only

Catching up

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