Dengue Updates

The good people at ProMed Mail has just sent out some new info on Dengue activity. For the “hard core” out there, you can get all the info form the above link. Here’s a brief summary on where they are saying the problems are:

Martinique, Carribean
Still in the apparent midst of their Dengue epidemic, the island nation of 430,000 people have a total of 6,400 suspected cases, this year. A few fatalities due to Dengue Hemorrhagic Fever (DHF) have also been reported.

Belize
A total of 80 confirmed cases here, with most of them being in Belize City or Corozal District. The government is encouraging citizens to help decrease the mosquito population by eliminating standing water and potential breeding sites.

Costa Rica
24,000 new cases, this year. Puntarenas and Limon seem to be the host spots, in the country. Also, there are 250 reported cases of DHF.

Vietnam
80,000 new cases this year with the provinces of Dong Thap, Tien Giang, and An Giang leading the number of reports.

Karachi, Pakistan
After being a little shy about sharing information on new cases, Karachi hospitals have started talking. 534 new cases this year and a bit of a problem with correct diagnosis, it seems. There is some speculation of under-reporting the number of new cases due to problems with their testing methods.

If all this bug and infection talk got you interested, check out more on Dengue Fever over at: Adventure Doc Dengue Page

Stoked!

I know it is not a technological miracle that I was able to link the newly started blog and the website, but I am pretty damn proud of myself. I am not the best in the wordl, when it comes to websites and publishing, etc. Well, just visit the site, and you’ll see.

I am glad I can finally make some “on the fly” posts about updates, outbreaks and other stuff that is is little more dynamic. I only update the website one per week and sometimes, that is not enough. Day job…what can you do?

I spent part of the day drooling over the new Wilderness Medicine Conference and being pissed I can’t go. I also saw some pretty cool field gear over at this site NARescue.com. They have some pretty decent looking trauma kits, airways, packs and diagnostic kits. Definately worth a look.

I also read a pretty good article about “Aircraft Cabin Air Recirculation and Symptoms of the Common Cold”. The study looked at the main factor of recycled air in the cabins of commercial airliners and its risk factor for catching a cold. The article basically said there was no increased risk of catching a cold while flying, commercially. I got the article from JAMA July 24/31, 2002 Vol. 288 No. 4. I always thought I seemed to get sick from commercial air travel. I guess not.

I am getting ready to work on the section of the website for “wilderness and remote orthopedic care”. Where to begin? How detailed to go? Ahhh, who cares, nobody reads this anyway.

Malaria Vaccine shows promise

Glaxo experimental malaria vaccine works in babies
Wed 17 Oct 2007, 16:00 GMT
Reuters Africa

By Ben Hirschler

LONDON, Oct 17 (Reuters) – African babies — the group most at risk of dying from malaria — may be protected against the mosquito-borne disease by an experimental vaccine, researchers said on Wednesday.

The finding clears the way for final-stage testing of GlaxoSmithKine Plc’s shot and increases the chance that the world will have a usable vaccine within five years.

Malaria kills one person every 30 seconds, most of them young African children. Doctors believe a vaccine, given as part of routine infant immunisation, is the best hope in fighting the disease.

A clinical trial in Mozambique of 214 infants aged 10 to 18 weeks found the vaccine was safe and reduced new infections by 65 percent over a three-month period after treatment. Clinical illness was cut by 35 percent over six months.

Although such efficacy rates are not as good as for some childhood vaccinations, experts believe the huge burden of malaria means the new shot can still save millions of lives.

“This is a very major breakthrough,” lead investigator Dr Pedro Alonso of the University of Barcelona told reporters in a conference call.

“These tantalising and unprecedented results further strengthen the vision that a vaccine may contribute to the reduction of the intolerable burden of disease and death caused by malaria.”

ONE MILLION DEATHS A YEAR

Malaria, caused by a parasite carried by mosquitoes, kills more than 1 million people every year and makes 300 million seriously ill.

The latest findings, published online in the Lancet, are broadly in line with a 45 percent reduction in new infections reported in 2004 when Glaxo’s vaccine, known as Mosquirix or RTS,S/AS02, was given to children aged 1- to 4-years old.

Mosquirix will now go into a large-scale Phase III trial in the second half of 2008, involving 16,000 infants and young children in seven African countries.

If all goes well, the vaccine — which is the most advanced of a number in development — will be submitted for regulatory approval in 2011, suggesting it could be commercially available in 2012.

Glaxo has promised to sell Mosquirix at low prices in developing countries. The exact price will be negotiated with purchasers, who are likely to be multilateral groups who would cover the cost on behalf of countries where malaria is endemic.

Glaxo has spent $300 million developing Mosquirix and expects to spend another $50 million to $100 million in future.

But the trials programme is also being financed by the nonprofit PATH Malaria Vaccine Initiative, helped by a $107 million grant from the Bill & Melinda Gates Foundation.

Mosquirix — which is given in three doses — targets just one stage in the malaria parasite’s life cycle and its success has surprised some scientists, given the complexity of the disease.

The fact that it works suggests an improved vaccine, targeting multiple elements in the life cycle, might be even more effective.

http://africa.reuters.com/wire/news/usnL17759798.html

Link to Story

Adventure Doc Malaria page

Think before you swim…This is Schistosome country

Schistosomes

Basics: Also known as Bilharziasis. This Trematode/blood fluke infection may lead to portal hypertension, liver fibrosis or bladder cancers, depending on location and length of infection. Eggs enter a freshwater pool, mature in snails and then become free swimming. They directly penetrate skin when it contacts infected water. Two species have a preference for mesenteric veins (Schistosoma Mansoni and S. Japonicium). Schistosoma Hematobium is generally found in the bladder.

Location: S. Mansoni is seen in Africa, South America and parts of Caribbean. S. Hematobium is found in Africa and Middle East. S. Japonicium is found mainly in China and Phillipines.

Transmission/Incubation: Transmitted by direct contact with infected water, allowing penetration of free-swimming cercariae. Eggs are deposited in water from infected person’s urine or feces.

Prevention: Avoidance of infected water, wearing of waterproof boots if wading, topical application of a 70% alcohol solution immediately after contact with infected water and vigorous drying

Diagnosis: Demonstration of eggs in Kato fecal smear or in urine. Urine filtration often facilitates demonstration. Various attempts are underway to have a rapid antigen analysis card for either blood or urine.

Treatment: Praziquantel single dose of 40mg/kg for S. Mansoni and S. Japonicium. A 60mg/kg dose may be used for S. Hematobium.

These are blood flukes and have two sexes, male and female. These parasites like to live in the bladder or mesenteric veins of the abdomen. There are several types of Schistosomiasis: Schistosoma Mansoni and S. Japonicium like to live in the mesenteric veins of the abdomen. Schistosoma Haematobium likes to live in the bladder.
These parasites clog the veins or bladder that they live in.

The life cycle of this parasite requires a snail to mature within. The eggs are passed from an infected individual, either in feces or urine. These eggs hatch miracidae (baby schistosomes) that mature within a snail, that lives in the water. Once they grow up a bit, they leave the snail and swim freely in the fresh water. These are known as cercariae (teenage schistosomes). These bad guys directly penetrate your skin while you are swimming or wading in the water.

To keep this from happening, wear waterproof boots while wading in the water. If you contact the water, vigorously dry skin and immediately rinse your body off with 70% alcohol solution after drying off, to kill the cercariae before they penetrate. This illness is found in Africa, Saudi Arabian peninsula, South America, the Middle East and some Caribbean islands. S. Mekongi and S. Intercalatum are two addition species worth mentioning. Katayama fever (systemic manifestation) is rare, but may occur 3-5 weeks after primary exposure.

Iodine or Chlorine may be used to disinfect water prior to bathing, laundry or drinking. Ensure 3-4 hours for treatment, prior to use.

Visit the Adventure Doc page for more info about this:
AdventureDoc Helminthes

Long Term Malaria Prophylaxis

Long Term Malaria Prophylaxis

I seem to be hearing this question a lot, lately. I will try to give a brief summary of what I know…

Atovaquone/Proguanil (Malarone)

Basically, there is not a lot of good literature on long term use of atovaquone/proguanil (Malarone). This seems to be an area that needs some more research. Most of the data that is being discussed, currently, centers around a short study of UN Peacekeepers who took the drug combo for approx 6 months with no severe reactions noted. It is a small study with only a few hundred patients, if memory serves. Nothing solid. The two drugs in the compound are both, individually, well studied and safe for long term use. Proguanil is not suitable for solo-protection as drug resistance is common. Oh, I got a good bit of info about malarone and it’s efficacy being increased when taken with a fatty meal versus an empty stomach. This appears to be true, as the fat in the meal helps it absorb. The EU has set a limit of use that ranges from 5 weeks to 3 months, depending on the country. The USA does not have any restriction on its use, with respect to time.

Chloroquine

Well studied and commonly used, often for long term use. The main thing to know is “Will this protect me?” This is only a drug to be used in geographic areas with known sensitivity to chloroquine. There is a link between long term chloroquine use and retinopathy (eye problems). Literature disagrees on how many YEARS that is, but a commonly accepted value is 5 years of 300 miligrams per week or 3 years if taking 100 miligrams per day. Most all people I see and talk with get advised to have a regular eye exam (every 6 months) after 2-3 years of any dose of chloroquine.

Mefloquine (lariam)

There is a lot of study on the long term use of this medication and it seems to be safe for long term use. If you can tolerate the mefloquine for the first 3-4 weeks, you should be fine for several years of use.

Doxycycline

Again, if you can tolerate the side effects of the medication (sun sensitivity, risk of vaginal yeast infections, GI/diarrhea and dietary restrictions), this medication seems safe for long term use, greater than 6 months. Most of the studies do not show any data of use longer than six months.

This information is from a collection of resources including:

Travel and Tropical Medicine Manual
Author: Jong and McMullen

TravMed
TravMed.com

Pretty good journal link about long term malaria protection (technical)
Malaria Prophylaxis for Long-Term Travelers
This is a PDF from Communicable Disease and Public Health

Many, many issues of The Journal of Travel Medicine and too many years of higher education.
If there are any other opinions or sources out there that have some good data, please send them to me…I am always trying to learn more!

Adventure Doc Malaria Page

Wilderness Medicine Conference

Unfortunately, I cannot attend these conferences…But I thought I would spread the word because they are going to be great! Anybody with an interest in wilderness medicine should consider going to these events.

You can learn some great survival skills, how to treat AMS (acute mountain sickness) and altitude related problems, diving medicine, treatment of ski and snowbaord injuries, travel with kids in the wilds, lightening strikes, navigation and a chance to get in some ski/board time, when not learning! Both conferences are accredited by the WMS (wilderness medical society) and have some of the best instructors in the field.

Anyway, I am jealous of anybody who gets to go…have fun for me! Also, if you go, you have to tell me about it!

Here is the link:
wilderness-medicine.com

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