Scott McPherson's Web Presence

While I was flat on my back, wishing my local health people had a test for Ad14 that I could test (positive) for, a few seemingly random news stories came across my bedside table.  When treated separately, they just appear to be common news.  When looking at the Big Picture, however, they reveal a disturbing trend.

First up is the developing situation in Paraguay.  Paraguay is located in South America, and is bordered on the northeast and southeast by Brazil.  Brazil has experienced a few recent outbreaks of yellow fever in the interior of the country, resulting in several deaths.  This is no surprise; Yellow fever is endemic to Brazil's rural interior.  But the reaction of Brazilians to the new outbreaks was an interesting sociological phenomenon.  Literally hundreds of thousands of Brazilians began clamoring for yellow fever vaccine, and several medical centers were overrun by anxious Brazilians seeking shots.

From the Reuters story of last month, Millions seek shots in Brazil yellow fever scare:

The government has denied the country faces an epidemic of the mosquito-borne disease. But authorities are warning tourists traveling to Brazilian forests, national parks and rural areas to get vaccinated at least 10 days before their trips.

More than half of Brazil's 27 states are partially or entirely yellow fever risk areas, including the Amazon and Brasilia. Most of the coast, which attracts the bulk of tourists, is considered free of the disease.

As fears of an outbreak mounted, the Health Ministry gave states more than 3.2 million doses of yellow fever vaccines this month, more than three times the average monthly distribution in 2007.

On Sunday, people in Sao Paulo stood in line for more than four hours at an airport health station to get shots, according to local media. In Brasilia, hospitals temporarily ran out of vaccines last week as demand surged.
http://uk.reuters.com/article/homepageCrisis/idUKN15537481._CH_.242020080115

Now back to beautiful Paraguay, home to jungles, crops and former Nazis on the run: Paraguay is experiencing a similar resurgence of yellow fever, with one important distinction:  A case of yellow fever had not been reported in Paraguay in 34 years.  There have been more Mengele sightings than human yellow fever cases over the past three decades!  Suddenly, and despite the government's attempts at stamping out the disease, no less than five documented human cases occurred at the same time, at a central farming camp, according to AP:

Yellow fever outbreak strikes Paraguay

ASUNCION, Paraguay - Paraguay asked international health authorities on Thursday to supply 600,000 doses of vaccine for yellow fever after the first cases were detected in the country in 34 years.

Antonio Barrios, a public health official, said the government had 100,000 vaccine doses but wanted to bolster stocks as a "reserve measure" after five cases of yellow fever were detected this week in a central farming region.

Barrios said the request was being made to the Pan American Health Organization. An expert on vaccination issues at the Washington-based offices was not immediately available for comment.

Barrios said the five cases of the mosquito-borne viral disease were found in and around a town in rural San Pedro department some 240 miles (400 kilometers) from the border with Brazil. In January, Brazil reported eight deaths after an outbreak in rural areas.

No deaths from yellow fever have been confirmed in Paraguay, but health officials said it was awaiting pathologists' reports on two people who died recently of unknown causes.

"Pathologists are working in the laboratory to determine whether they died as a result of yellow fever or as a result of some other ailment," public health minister Oscar Martinez said.

The government has announced vaccination plans in and around San Pedro of all those between 1 and 60 years of age. Others were also seeking vaccinations elsewhere at public hospitals.

http://www.msnbc.msn.com/id/23058833/

Then, local residents began behaving like -- like, well, like Brazilians.  Also from the AP:

4,000 block Paraguay road, demand vaccines

ASUNCION, Paraguay - Some 4,000 people demanding vaccinations against yellow fever blockaded a highway near the capital Wednesday, a week after the disease made its first appearance in Paraguay in 34 years.

The blockade snarled traffic for hours on a major route near Asuncion before authorities negotiated a peaceful end to the demonstration, police officer Francisco Monges said. There were no reports of violence.

Paraguayan health officials last week announced five confirmed cases of yellow fever that originated in a remote farm community, but no deaths. The outbreak prompted South America's second-poorest country to urgently request 600,000 doses of vaccine from international health authorities.

Demonstrators complained the government had been caught short of doses and demanded a major vaccination campaign against the mosquito-borne disease. Hundreds of people lined up this week at hospitals around Paraguay, demanding vaccines that were unavailable.

Separately, Paraguayan health officials said they were preparing to rush in 50,000 vaccines on a refrigerated plane from Brazil. Peru also had pledged thousands of doses.

Paraguayan authorities had no immediate response to calls for a wider vaccination campaign. They initially said they were concentrating vaccination efforts on residents of the affected community of San Pedro, some 240 miles from the border with Brazil.

The last reported case of yellow fever in Paraguay was in 1974.

The World Health Organization says an estimated 30,000 people worldwide die annually from the disease. Symptoms can include fevers, vomiting, jaundice and bleeding from the mouth, nose, eyes and stomach.

http://www.msnbc.msn.com/id/23149574/

And wouldn't you know it, dagnabbit, but somebody forgot to go to the store and restock the Yellow Fever vaccine.  Hot off the presses today, from Reuters:

Global supply of yellow fever vaccine depleted-WHO

GENEVA, Feb 27 (Reuters) - The world's supply of vaccine against yellow fever, which kills tens of thousands each year, is under extreme pressure, a senior World Health Organisation (WHO) official said on Wednesday.

So there is a buzz (forgive the terrible pun) going round in South America about the reappearance of Yellow Fever.  Add that to the list of things steadily heading our way, along with Dengue fever and the spread of West Nile Virus in the continental US.  Here in Florida, attention is turned toward local government budget cuts, and one of the first things slated for elimination is:  Mosquito control.  Let me state again:  West Nile Virus is here.  Dengue is coming, maybe on the next flight from Santo Domingo to Miami.  And now, at this time, local governments want to cut mosquito control? 

It's not like we haven't been through a yellow fever disaster before in the United States.  I refer you to Molly Caldwell Crosby's excellent book The American Plague, which details the 1878 plague's effects upon the hapless city of Memphis.  An Amazon.com review of the book concludes:

Over the course of history, yellow fever has paralyzed governments, halted commerce, quarantined cities, moved the U.S. capital, and altered the outcome of wars. During a single summer in Memphis alone, it cost more lives than the Chicago fire, the San Francisco earthquake, and the Johnstown flood combined.

Now let's turn our attention to yesterday's AP story about the alarming spread of drug-resistant tuberculosis across the planet.

Drug-resistant TB spreading fast

LONDON - Drug-resistant tuberculosis is spreading even faster than medical experts had feared, the World Health Organization warned in a report issued Tuesday.

The rate of TB patients infected with the drug-resistant strain topped 20 percent in some countries, the highest ever recorded, the U.N. agency said.

"Ten years ago, it would have been unthinkable to see rates like this," said Dr. Mario Raviglione, director of WHO's "Stop TB" department. "This demonstrates what happens when you keep making mistakes in TB treatment."

Though the report is the largest survey of drug-resistant TB, based on information collected between 2002 and 2006, there are still major gaps: Data were only available from about half of the world's countries.

In Africa, where experts are particularly worried about a lethal collision between TB and AIDS, only six countries provided information.

"We really don't know what the situation is in Africa," Raviglione said. "If multi-drug resistant TB has penetrated Africa and coincides with AIDS, there's bound to be a disaster."

Raviglione said it was likely that patients — and even entire outbreaks of drug-resistant TB — were being missed.

Drug-resistant strain now in 45 countries
Experts also worry about the spread of XDR-TB, or extensively drug-resistant TB, a strain virtually untreatable in poor countries. When an XDR-TB outbreak was identified in AIDS patients in South Africa in 2006, it killed nearly every patient within weeks. WHO's report said XDR-TB has now been found in 45 countries.

Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5 percent of the 9 million new TB cases. In the United States, 1.2 percent of TB cases were multi-drug resistant. Of those, 1.9 percent were extensively drug-resistant.

The highest rates of drug-resistant TB were in eastern Europe. Nearly a quarter of all TB cases in Baku, Azerbaijan, were drug-resistant, followed by about 20 percent in Moldova and 16 percent in Donetsk, Ukraine, WHO said.

High rates of drug-resistant TB were also found in China and India, the world's two most populous nations that together are home to half the world's cases.

Drug-resistant TB arises when primary TB treatment is poor. Countries with strong treatment programs, like the U.S. and other Western nations, should theoretically have very little drug-resistant TB.

That is not the case in China, however, where the government says 94 percent of TB patients complete their first TB treatment.

"There's a huge, gross discrepancy there if they are then reporting 25 percent of the world's multi-drug resistant TB cases," said Mark Harrington, executive director of Treatment Action Group, a public health think tank. "They are clearly nurturing a multi-drug resistant TB epidemic and failing to report XDR-TB at all." (bold mine)

With growing numbers of drug-resistant TB patients, there is concern some national health systems will soon be overwhelmed.

New drugs needed
"We are totally off track right now," said Dr. Tido von Schoen-Angerer, executive director of Medecins Sans Frontiere's Campaign for Access to Essential Medicines. He said only 30,000 multi-drug TB resistant patients were treated last year.

Experts said new drugs are needed if the outbreak is to be curbed, along with new diagnostic tests to identify drug-resistant TB strains faster — current tests take about a month for results.

WHO said a new diagnostic test able to provide results within a day is being tried in South Africa and Lesotho. If successful, the test could be introduced across Africa in a few months, though new labs would be needed to run the tests.

"Multi-drug resistant TB is a threat to every person on the planet," Harrington said. "It's not like HIV, where you are only infected through specific actions. TB is a threat to every person who takes a train or a plane." (bold mine)

http://www.msnbc.msn.com/id/23356049/

Where did we ever get off thinking we had "conquered" disease?  Look at the data on XDR-TB, the most lethal form of the disease.  Look also at where these cases are multiplying:  China.  India.  Russia and former Soviet territories.  Did I mention China, home to the 2008 Olympics? 

I have heard statistics in the recent past rearding the number of MDR-TB (that's moderately drug-resistant) and XDR-TB (or eXtensively drug-resistant) in the former Soviet Union.  How about 200,000 new cases a year?

Please allow me to pull directly from the Website of the Woodrow Wilson International Center for Scholars:

The substantial success in controlling TB during the Soviet years has been lost, and TB deaths have skyrocketed in Russia over the past 18 years, particularly among working-age men. Much of this increase is due to overcrowding in urban centers, and in prison populations especially, explained Dr. Keshavjee. Globally, TB strains—including MDR- and XDR-TB strains—kill approximately 1.8 million people per year, he said, disproportionally affecting the poor and immunocompromised.

Worldwide each year there are approximately 400,000 cases of MDR-TB tuberculosis, strains that are resistant to the first-line and most effective TB drugs, and often select second-line drugs. Due to the relative weakness of second- and third-line drugs, effective treatment of MDR-TB often requires an 18-24 month course of rigorously managed, directly observed therapy. XDR-TB strains are only susceptible to questionably effective third-line drugs. Because of this, XDR-TB requires a longer course of drugs and often times surgery if treatment is effective at all. Russia has a 14 percent prevalence of XDR-TB among TB positive patients, one of the highest rates in the world. Particularly frightening, said Dr. Keshavjee, is the increase in person-to-person spread of drug-resistant TB: “At least 10 percent of new cases of TB in the [former Soviet Union] are MDR [strains] and 50 percent of re-treated cases are MDR.” 

...In addition to the extremely slow response to TB, mentioned earlier, it is also difficult to accurately determine how many people may be suffering from TB due to inadequate data collection systems within Russia. While Russian officials claim 120,000 new TB cases per year, the World Health Organization puts the number closer to 150,000-160,000, he said. MDR-TB rates are even more difficult to judge, with broad estimates for those receiving treatment ranging from 17,000 to 58,000. Feshbach emphasized the importance of remembering that Russian statistics only include first incidence of TB, so relapse and re-treatment are not included in the counting. There are also inaccuracies in counting deaths when both HIV and TB are detected. HIV deaths due to TB are counted as an AIDS death, not a TB death. (bold mine)
http://www.wilsoncenter.org/index.cfm?topic_id=116811&fuseaction=topics.event_summary&event_id=239772

We are aware of the American citizen who was in indefinite, judge-ordered lockup in a Phoenix, Arizona jail for months because he refused to treat his XDR-TB with the proper respect.

Anna Spector's Infectious Diseases Blog

Robert Daniels made headlines in the United States when he was put in solitary confinement in a hospital ward after disobeying a judge's order to wear a mask (he went to a 7/11). He was diagnosed with a kind of tuberculosis that is very difficult to treat, XDR TB. Daniels, whose mother is Russian, and father is American, had been living in Moscow, but decided that TB treatment would be better in the US, so he went to Arizona. After a year of forced hospitalization and the removal of one lung, Russia Today reports that Daniels is better, but that Arizona officials wanted him to continue treatment he thought was not necessary. So Daniels has fled back to Moscow.

Among the torture Daniels' lawyer says he was submitted to were 24 hour a day light, and no telephone calls or TV.

http://infectiousdiseases.about.com/b/2007/10/16/xdr-tb-causes-robert-daniels-to-flee-us.htm

Well, at least he is back with his droogs, eh?    Good luck to us all.