En África es más fácil conseguir una Coca-Cola que una vacuna

LUNES, 27 JUNIO 2011

La GAVI Alliance declaró hace unos días la siguiente década como la 'década de las vacunas'. Su objetivo es evitar la muerte de seis millones de niños de aquí al 2020. / Doune Porter (GAVI Alliance, unless stated otherwise)

“Podemos llevar Coca-Cola a todo el mundo, pero parece que no podemos llevar medicinas para salvar a un niño de algo tan simple como una diarrea”, dijo la cantante Annie Lennox hace unos años. Ahora, un equipo de investigadores han querido comprobar si aquella frase iba más allá de la anécdota. Sin embargo, han encontrado que en muchas zonas del África subsahariana es más fácil conseguir productos como una tarjeta para recargar el móvil que un antibiótico. Si la situación se revirtiera, se podrían salvar las vidas de más de seis millones de niños y ahorrar 231.000 millones de dólares.

El Centro Internacional para el Acceso a las Vacunas (IVAC), que depende de la Johns Hopkins Bloomberg School of Public Health, ha publicado esta semana un estudio donde importan más los datos que sus conclusiones. El trabajo constata que el suministro de mercancías a muchas zonas se enfrenta a un sinfín de dificultades: malas comunicaciones, lejanía de los grandes centros de distribución, deficientes sistemas para el mantenimiento de la cadena de frío y, ya en destino, pequeñas tiendas que no tienen las condiciones mínimas para un almacenamiento decente.

Sin embargo, la ratio de disponibilidad de bienes de consumo es varias veces superior a la de las medicinas. En Tanzania, por ejemplo, la gentamicina o la ceftriaxona inyectables (potentes antibióticos que se usan en infecciones graves) es entre 10 y 18 veces más difícil de encontrar que las tarjetas prepago para los móviles. Mientras, en Kenia la posibilidad de que no haya existencias de amoxicilina triplica a la de las recargas.

Pero además de las dificultades que comparten con otros bienes, las medicinas sufren algunas extra. Los medicamentos necesitan que los niveles de humedad y temperatura no sobrepasen unos umbrales. La mayoría de los antirretrovirales, por ejemplo, necesitan viajar refrigerados. Otras formulaciones han de ser administradas por personal especializado, lo que complica su distribución.

El resultado de todo esto es que buena parte de los medicamentos que los bienintencionados de Occidente donan o pagan nunca llegan a su destino o llegan inservibles. Los investigadores sostienen que se pierden unos 30 millones de dosis de vacunas por una deficiente cadena de frío. Mejorando los sistemas de gestión, distribución y almacenamiento se podrían ahorrar 162 millones de dólares al año. Otros elevan las cifras del desperdicio. Un trabajo reciente de la Gavi Alliance, donde participan grandes países donantes, Unicef o la OMS, estimó que se pierden entre 25 y 50 millones de dosis en los países menos desarrollados sólo de la vacuna pentavalente, que sirve para inmunizar contra la difteria, tos ferina, tétano, influenza tipo b o hepatitis B.

La solución que dan los autores del trabajo es que la distribución de las medicinas copie la de los bienes de consumo. Ponen como ejemplo a los sistemas de distribución que ha montado la compañía Coca-Cola en algunas zonas de áfrica. Su nombre, Centros de Distribución Manual, lo dice todo. Carros tirados por bueyes o por los mismos vendedores han conseguido llevar la chispa de la vida a los rincones más remotos de Kenia o Tanzania. Fuera de la anécdota, el informe cree firmemente que la asociación con el sector privado puede acabar con la ineficiencia que provoca tanto despilfarro de medicinas.

Pero, como también reconocen los autores, esta colaboración ideal entre empresas e instituciones u organizaciones sanitarias tiene varias limitaciones. La básica, que ellos mencionan casi de pasada, es que mientras que la distribución de los refrescos y las tarjetas prepago se basa en el beneficio que cada eslabón de la cadena obtiene, la de las vacunas se basa en maximizar el acceso de la población al menor coste posible. Como el agua y el aceite.

http://www.cuartopoder.es/mecanicamente/en-africa-es-mas-facil-conseguir-una-coca-cola-que-una-vacuna/470

Dengue virus circulating between monkeys and mosquitoes could emerge to cause human outbreaks

More than a thousand years ago, somewhere in Southeast Asia, a fateful meeting occurred between a mosquito-borne virus that infected mainly monkeys and a large, susceptible group of humans. Today, dengue virus -- which can produce high fever, excruciating joint pain and even death -- has spread throughout tropical Asia, Africa and South America, and in 2008 it re-appeared in the Florida Keys. It could be even more widespread along the U.S. Gulf Coast but there is no surveillance in place to detect it. Annually dengue strikes about 100 million people and causes an estimated 50,000 deaths, thriving in the urban environments infested by Aedes aegypti, the mosquito species primarily responsible for human dengue transmission. Meanwhile, the virus' forest-dwelling counterpart -- known as "sylvatic dengue" -- continues to flourish in Southeast Asia and West Africa, cycling between non-human primates and the mosquitoes that feed on them. Since the 1970s, sylvatic dengue has received very little scientific attention -- a situation that badly needs to be remedied, according to the authors of "Fever from the forest: Prospects for the continued emergence of sylvatic dengue virus and its impact on public health," an article published online June 13 in Nature Reviews Microbiology.

"This virus continues to circulate in the forests, and now economic and ecological pressures are driving more and more people into the forests in Africa and Southeast Asia," said University of Texas Medical Branch at Galveston assistant professor Nikos Vasilakis, lead author of the paper. "In the last 10 years we've seen a number of outbreaks of disease with real public health impact caused by what we call zoonotic viruses, viruses that start out in wild animals but can also be transmitted to humans -- look at SARS, Nipah and Hendra, for example. Sylvatic dengue could be capable of a similar emergence -- or rather, re-emergence, since we know previous dengue spillovers into urban and near-urban settings have occurred." Dengue virus may also be capable of movement from the widespread urban cycles into primates and forest mosquitoes of Latin America, which would establish a new reservoir for human infections in the New World. In the paper, Vasilakis and his collaborators identify two factors that make a dengue re-emergence a "clear and present danger": rapid human population growth near and in tropical forests, and the fact that little or no genetic change would be needed for sylvatic dengue to adapt to human hosts and urban mosquitoes. "Experiments show that there is little or no adaptive barrier to the emergence of sylvatic dengue into human populations," Vasilakis said. "In other words, the virus can emerge from its current environment at any time, without further adaptation."The article also presents additional reasons for boosting research into sylvatic dengue, among them the possibility that its behavior in nonhuman primate animal models might offer critical new perspectives on the pathology of human dengue. (Most monkeys tested so far show no clinical signs of the disease, limiting their usefulness as experimental models.) Another significant issue is the possibility that vaccines against human dengue, which could be licensed in as little as five years, might push the virus to the brink of eradication in the urban, human transmission cycle, leaving an ecological opening that could be filled by sylvatic dengue. "We see a precedent for this with yellow fever, where we have a very good vaccine -- urban yellow fever has been nearly eliminated in some regions -- but we don't have good vector control programs, and especially in South America we now have outbreaks fueled by sylvatic yellow fever," Vasilakis said. "If we eradicate human dengue and then stop vaccinating, as we often do after the disease disappears, we could see a re-emergence of dengue from a sylvatic source."With the exception of a research program in Malaysia that ended in 1975, fieldwork on sylvatic dengue has been minimal, according to Vasilakis. In the article, he and his fellow authors call for new surveillance programs to monitor mosquitoes, non-human primates and humans in areas where sylvatic dengue is endemic, as well as the development of new diagnostic tools that will enable researchers to more easily accomplish those studies. "Of all the viruses with the potential to shift from animals into humans, the most likely to do so are those that, like sylvatic dengue, are carried by the non-human primates and/or bats," Vasilakis said. "For our own good, we need to know as much as we can about this virus."Science DailyJune 28, 2011Original web page at Science Daily 

http://www.vetscite.org/publish/items/006687/index.html

Campilobacteriose transmitida por leite não pasteurizado (Texto em Inglês)

CAMPYLOBACTERIOSIS, UNPASTEURIZED MILK - USA: (WISCONSIN)
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 17 Jun 2011
Source: Wisconsin Business [edited]
<http://www.wisbusiness.com/index.iml?Article=239824>


Laboratory test results show that the _Campylobactor jejuni_bacterium
that caused diarrheal illness among 16 individuals who drank
unpasteurized (raw) milk at a school event early this month in Raymond
was the same bacterial strain found in unpasteurized milk produced at
a local farm, according to officials from the Department of Health
Services (DHS) and Western Racine County Health Department (WRCHD). A
parent had supplied unpasteurized milk from the farm for the school
event.

Stool samples submitted to the WRCHD by ill students and adults were
sent to the State Laboratory of Hygiene where they tested positive for
the bacterium. Department of Agriculture, Trade and Consumer
Protection (DATCP) food inspectors collected milk samples from the
bulk tank at the farm, which tested positive for _Campylobacter
jejuni_. Further testing by the State Hygiene lab showed the bacterial
strains from the stool samples and the milk samples matched.

Additionally, interviews with event attendees revealed that consuming
the unpasteurized milk was statistically associated with illness.
Health officials said that this combination of laboratory and
epidemiological evidence indicates that the illnesses were caused by
the unpasteurized milk consumed at the school event.

The farm did not sell the unpasteurized milk and there was no legal
violation associated with the milk being brought to the school event.
The farm is licensed and in good standing with the Department of
Agriculture, Trade and Consumer Protection.

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[Clusters of infection continue to be reported each year caused by
the ingestion of raw milk. Its advocates vehemently argue regarding
the value of the product but the science supporting its use is minimal
at best. Regarding whether raw milk safety and its increased
nutritional value has been "adequately documented by both the USDA and
the FDA, the following is from the FDA in 2004, "Got Milk? Make Sure
It's Pasteurized":

Pasteurization, since its adoption in the early 1900s, has been
credited with dramatically reducing illness and death caused by
contaminated milk. But today, some people are passing up pasteurized
milk for what they claim is tastier and healthier "raw milk." Public
health officials couldn't disagree more.

Drinking raw (untreated) milk or eating raw milk products is "like
playing Russian roulette with your health," says John Sheehan,
director of the Food and Drug Administration's Division of Dairy and
Egg Safety. "We see a number of cases of foodborne illness every year
related to the consumption of raw milk."

More than 300 people in the USA got sick from drinking raw milk or
eating cheese made from raw milk in 2001, and nearly 200 became ill
from these products in 2002, according to the CDC.

Raw milk may harbor a host of disease-causing organisms (pathogens),
such as the bacteria _Campylobacter_, _E. coli_, _Listeria_,
_Salmonella_, _Yersinia_, and _Brucella_. Common symptoms of foodborne
illness from many of these types of bacteria include diarrhea, stomach
cramps, fever, headache, vomiting, and exhaustion. Most healthy people
recover from foodborne illness within a short period of time, but
others may have symptoms that are chronic, severe, or
life-threatening.

People with weakened immune systems, such as elderly people,
children, and those with certain diseases or conditions, are most at
risk for severe infections from pathogens that may be present in raw
milk. In pregnant women, _Listeria monocytogenes_-caused illness can
result in miscarriage, fetal death, or illness or death of a newborn
infant. _E. coli_ infection has been linked to hemolytic uremic
syndrome, a condition that can cause kidney failure and death.

Some of the diseases that pasteurization can prevent are
tuberculosis, diphtheria, polio, salmonellosis, strep throat, scarlet
fever, and typhoid fever.

Pasteurization and contamination
--------------------------------
The pasteurization process uses heat to destroy harmful bacteria
without significantly changing milk's nutritional value or flavor. In
addition to killing disease-causing bacteria, pasteurization destroys
bacteria that cause spoilage, extending the shelf life of milk.

Milk can become contaminated on the farm when animals shed bacteria
into the milk. Cows, goats, and sheep carry bacteria in their
intestines that do not make them sick but can cause illness in people
who consume their untreated milk or milk products.

But pathogens that are shed from animals aren't the only means of
contamination, says Tom Szalkucki, assistant director of the Wisconsin
Center for Dairy Research at the University of Wisconsin-Madison. Cows
can pick up pathogens from the environment just by lying down, giving
germs the opportunity to collect on the udder, the organ from which
milk is secreted. "Think about how many times a cow lays down in a
field or the barn," says Szalkucki. "Even if the barn is cleaned
thoroughly and regularly, it's not steamed. Contamination can take
place because it's not a sterile environment."

The health hype
---------------
Raw milk advocates claim that unprocessed milk is healthier because
pasteurization destroys nutrients and the enzymes necessary to absorb
calcium. It also kills beneficial bacteria and is associated with
allergies, arthritis, and other diseases, they say.

This is simply not the case, says Sheehan. Research has shown that
there is no significant difference in the nutritional value of
pasteurized and unpasteurized milk, he says. The caseins, the major
family of milk proteins, are largely unaffected, and any modification
in whey protein that might occur is barely perceptible.

"Milk is a good source of the vitamins thiamine, folate, B-12, and
riboflavin," adds Sheehan, "and pasteurization results in losses of
anywhere from zero to 10 percent for each of these, which most would
consider only a marginal reduction."

Vitamin D
While the major nutrients are left unchanged by pasteurization,
vitamin D, which enhances the body's absorption of calcium, is added
to processed milk. Vitamin D is not found in significant levels in raw
milk.

Enzymes
"Pasteurization will destroy some enzymes," says Barbara Ingham, PhD,
associate professor, and extension food scientist at the University of
Wisconsin-Madison. "But the enzymes that are naturally present in milk
are bovine enzymes. Our bodies don't use animal enzymes to help
metabolize calcium and other nutrients. Enzymes in the food that we
eat and drink are broken down in the human gastrointestinal tract,"
adds Ingham. "Human bodies rely on our own native enzymes to digest
and metabolize food. Most of the native enzymes of milk survive
pasteurization largely intact," says Sheehan, "including those thought
to have natural antimicrobial properties and those that contribute to
prolonging milk's shelf life." Other enzymes that survive are thought
to play a role in cheese ripening.

Ingham says that pasteurization will destroy some bacteria that may
be helpful in the fermentation of milk into products such as cheese
and yogurt, "but the benefit of destroying the harmful bacteria vastly
outweighs the supposed benefits of retaining those helpful
microorganisms. Plus, by adding the microorganisms that we need for
fermentation, we can assure a consistently high quality product."

Science has not shown a connection between drinking raw milk and
disease prevention. "The small quantities of antibodies in milk are
not absorbed in the human intestinal tract," says Ingham. "And there
is no scientific evidence that raw milk contains an anti-arthritis
factor or that it enhances resistance to other diseases."

Fans of raw milk often cite its creamy rich taste, says Szalkucki,
who adds that it may be creamier because it is not made according to
the standards for processed milk. "If you go to a grocery store and
buy fluid milk, it's been standardized for a certain percentage of
fat, such as 2 percent," he says. "Raw milk is potentially creamier
because it has not been standardized and it has a higher fat
content."

The law
-------
It is a violation of federal law enforced by the FDA to sell raw milk
packaged for consumer use across state lines (interstate commerce).
But each state regulates the sale of raw milk within the state
(intrastate), and some states allow it to be sold. This means that in
some states, dairy operations may sell it to local retail food stores
or to consumers directly from the farm or at agricultural fairs or
other community events, depending on the state law.

In states that prohibit intrastate sales of raw milk, some people
have tried to circumvent the law by "cow sharing," or "cow leasing."
They pay a fee to a farmer to lease or purchase part of a cow in
exchange for raw milk, claiming that they are not actually buying the
milk since they are part owners of the cow. Wisconsin banned
cow-leasing programs after 75 people became infected with
_Campylobacter jejuni_ bacteria in 2001 from drinking unpasteurized
milk obtained through such a program.

Raw milk cheeses
----------------
The FDA allows the manufacture and interstate sale of raw milk
cheeses that are aged for at least 60 days at a temperature not less
than 35 deg F (2 deg C). "However, recent research calls into question
the effectiveness of 60-day aging as a means of pathogen reduction,"
says Sheehan.

The FDA's Center for Food Safety and Applied Nutrition (CFSAN) is
currently examining the safety of raw milk cheeses and plans to
develop a risk profile for these cheeses. This information will help
FDA risk managers make future decisions regarding the regulation of
these products to protect public health.

Ensuring milk safety
--------------------
The FDA provides oversight for the processing of raw milk into
pasteurized milk, cottage cheese, yogurt, and sour cream under the
National Conference on Interstate Milk Shipments "Grade A" milk
program. This cooperative program between the FDA and the 50 states
and Puerto Rico helps to ensure the uniformity of milk regulations and
the safety of milk and milk products. The program is based on
standards described in the FDA's Pasteurized Milk Ordinance (PMO), a
model code of regulations that can be adopted by the states in their
own regulations.

Under the "Grade A" program, state personnel conduct inspections and
assign ratings, and FDA regional milk specialists audit these ratings,
says Richard Eubanks, MPH, a senior milk sanitation officer on CFSAN's
Milk Safety Team. "It's a rigorous process of inspection and
auditing," he says, and "it covers from cow to carton," starting with
the dairy farm and continuing through the processing and packaging of
products at milk plants. Products that pass inspection may be labeled
"Grade A."

The FDA "Grade A" milk program includes pasteurized milk from cows,
goats, sheep, and horses. Raw milk and raw milk cheeses cannot be
labeled "Grade A," since they are not pasteurized and not covered
under the program. - Mod.LL]

[The interactive HealthMap/ProMED map for Wisconsin is available at:
<http://healthmap.org/r/00Pq> - CopyEd.EJP]

[see also:
2010
----
Campylobacteriosis, E. coli O157, unpasteurized goat milk - USA: (CO)
20100711.2318
Salmonellosis, unpasteurized milk - USA (02): (UT) serotype Newport
20100709.2287
Salmonellosis, unpasteurized milk - USA: (UT)  20100517.1616
Campylobacteriosis, unpasteurized milk - USA: (MI ex IN)
20100329.0981
2009
----
Campylobacteriosis, unpasteurized milk - USA (02): (WI)
20090917.3264
Campylobacteriosis, unpasteurized milk - USA: (CO)  20090415.1430
2008
----
Campylobacteriosis, unpasteurized milk - USA (CA)  20080817.2557
2007
----
Campylobacteriosis, unpasteurized milk - USA (KS)  20071205.3922
Salmonellosis, serotype Typhimurium, raw milk - USA (02): (PA), CDC
report 20071108.3629
Salmonellosis, free unpasteurized milk - USA (PA) (03)
20070815.2667
Campylobacteriosis, unpasteurized milk - USA (GA)  20070803.2520
Salmonellosis, free unpasteurized milk - USA (PA)  20070722.2354
Listeriosis, unpasteurized cheese - USA (IN)  20070425.1351
Campylobacteriosis, unpasteurized milk - USA (UT) (02)
20070324.1033
Campylobacteriosis, unpasteurized milk - USA (UT)  20070322.1004
Salmonellosis, serotype Typhimurium, raw milk - USA (PA)
20070303.0748
E. coli O157, unpasteurized milk, 2005 - USA (WA)  20070302.0741
2006
----
Foodborne illness, unpasteurized milk - USA (OH)  20060929.2794
E. coli O157, unpasteurized milk - USA (CA) (03)  20060929.2791
E. coli O157, unpasteurized milk - USA (WA): recall  20060929.2790
E. coli O157, unpasteurized milk - USA (CA) (02): background
20060927.2761
E. coli O157, unpasteurized milk - USA (CA)  20060922.2706
E. coli O157, unpasteurized milk - USA (OR, WA) (04)  20060121.0199
2005
----
E. coli O157, unpasteurized milk - USA (OR, WA)  20051216.3622
2003
----
Salmonellosis, raw milk - USA (Ohio) (03)  20030204.0308
Salmonellosis, raw milk - USA (Ohio)  20030105.0033]
.................................................sb/ll/ejp/mpp
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UC Davis Children's Hospital patient becomes third person in U.S. to survive rabies

2/06/2011 04:34:00

(SACRAMENTO, Calif.) — Precious Reynolds, an 8-year-old resident of rural Humboldt County, has become the third person in the United States known to have recovered from rabies infection without receiving the rabies vaccine, through the efforts of a team of dedicated physicians, nurses and therapists at UC Davis Children's Hospital.

The hospital team was led by Jean Wiedeman, associate professor of pediatric infectious diseases. Wiedeman coordinated Precious' care with state, local and federal officials at the U.S. Centers for Disease Control and Prevention (CDC), the California Department of Public Health's Encephalitis and Special Investigations Section, and county health departments in Humboldt and Sacramento counties.

Dr. Jean Wiedeman (left) and Precious Reynolds (right)

"Precious received superb care from everyone at UC Davis Children's Hospital," Wiedeman said. "And we were enveloped with support from the CDC and the state encephalitis group from the moment we learned she was infected," Wiedeman said. She said the consultations with national, state and local public-health officials occurred as often as 20 times a day in the early phases of the patient's treatment.

"From the very beginning, Precious had a very rapid, robust immune response to her infection, which is a significant contributor to why she survived," Wiedeman said. "She is truly a fighter."

Rabies is a highly infectious viral disease of mammals that usually is transmitted through the bite or scratch of a rabid animal. Because pets and farm animals typically are inoculated against the disease, exposure commonly comes from a bat, skunk, fox or other wild animal.

While it is not known how she became infected, public health officials suspect Precious may have encountered a feral cat near her elementary school in the tiny town of Willow Creek, Calif., near the Humboldt County border with Trinity County, though the infected animal never was found.

Rabies infection in humans is exceptionally rare in the United States, Wiedeman said, with only two-to-nine cases reported each year. Many more people — some 30,000 annually — are exposed and receive post-exposure prophylaxis (PEP) to prevent disease. 

Reynolds did not receive post-exposure prophylaxis, a series of antiviral inoculations administered following infection, because the date and nature of her exposure is not known. Rabies is virtually always fatal without PEP.

The virus affects the central nervous system, ultimately causing encephalitis, or acute inflammation of the brain, and eventually, death. Very early symptoms of rabies in people include fever, headache, and general weakness or discomfort. As the disease progresses, however, more specificsymptoms appear.

That was the case with Reynolds, according to her grandmother, Shirley Roby.

"It started with a stomach ache," said Roby, who immediately took Precious to the family physician, who suggested she might have appendicitis and recommended she be seen at a local hospital. The hospital ruled out appendicitis and suggested she had a case of the flu.

But as the child's condition continued to decline, she became unable to swallow, and began to feel pain in her neck and back. Eventually she would lose muscle control and the ability to stand or walk. Roby returned Precious to the community hospital.

"This isn't the flu," she told them pointedly. "To me, it looked more like polio."

The hospital transferred the child by ambulance to McKinleyville, Calif., where she was flown to Sacramento and transported to UC Davis Children's Hospital. She was admitted through the pediatric emergency department to the pediatric intensive care unit (PICU).

There, Wiedeman and critical care medicine colleagues, including physicians Jennifer Plant, Theresa Murdock-Vlautin and Mac Wayment, among others, evaluated Precious and determined that she had encephalitis.

Wiedeman specializes in the treatment of children with infectious diseases. She has specific expertise in the management of complex clinical cases, especially those with problematic diagnostic and management intricacies. She provided samples of Precious' blood and spinal fluid to the state Encephalitis and Special Investigations Section of the California Department of Public Health, directed by Carol Glaser, a physician and veterinarian and associate professor of pediatric infectious diseases at UC San Francisco.

Test results returned on May 5 indicated that Precious had rabies. Wiedeman, along with the UC Davis pediatric critical care doctors, the CDC and state encephalitis group, decided to treat her with a therapy first used in Wisconsin in 2004 on a 15-year-old girl who contracted rabies from a bat bite. Her physician placed the girl in a drug-induced coma while administering antiviral medication. There has been one other survivor, a patient in Texas in 2009, who did not receive treatment with this approach.

"This was a unique experience," Wiedeman said. "It was reassuring that the CDC and the state encephalitis group had our back," Wiedeman said. But more difficult was sharing the diagnosis with Roby and Precious' father, Willie Reynolds.

"You're aware that the child has a minimal chance of survival, that the protocol has been applied worldwide in 25 cases with only four survivors. You're not going to the family with good news if you've got a diagnosis of rabies. It's heartbreaking," Wiedeman said.

"None of us thought she would leave the PICU. When she did it was unbelievable," said Krystle Realyvasquez, a nurse who cared for Precious when she was first admitted to the intensive care unit and then before she graduated to the step-down unit.

The protocol requires a team approach to the patient's care. Realyvasquez was among a handful of nurses who treated Precious during her intensive care unit stay. "Being in that team environment, where everybody knows what's going on day-by-day, makes for more uniform care, so that we were better able to provide for her needs," she said.

As time passed, however, Precious' immune response gave Wiedeman and the rest of her health-care team and family reason for hope.

"I was very encouraged that with her diagnosis she continued to interact," Wiedeman said. "She was right there until we deepened her coma significantly. She could respond to you and had brisk pupillary responses throughout the coma. There were subtle signs that she was performing well given her diagnosis."

"To me, the most remarkable and lasting part of this experience is that you had a previously, healthy, very vigorous spunky little girl, who got diagnosed with an almost universally fatal disease, and none the less a dedicated team of physicians and nurses — and her father and grandmother, who never left her bedside — pulled her through this," said Jennifer Plant, assistant clinical professor of pediatric critical care medicine, a key member of the team.

"In a year her grandmother is going to send me a video of her wrestling. I am exceptionally proud and happy."

 Roby said that she never gave up on her granddaughter.

"At first my heart sank to my feet. But I guess doctors have to put on a suit of armor to tell parents the truth," Roby said. "I decided that we were just going to think positive."

Roby's instincts were right. She said that Precious received "excellent, excellent" care for two weeks in the pediatric intensive care unit and later in the general pediatric patient-care unit where she continues to receive treatment. The athletic little girl — a wrestler and rodeo sheep rider or "mutton buster" — is back on her feet and beginning to walk with the help of physical medicine and rehabilitation.

Roby said she that she is grateful to everyone who has cared for her granddaughter — particularly Wiedeman, for her devoted care for Precious.

"She fought for Precious tooth and nail," Roby said. "She is something special to me."

Wiedeman and Roby cautioned parents to admonish their children to avoid any and all contact with wild or feral animals — including dead ones — particularly bats. If exposed, Wiedeman said, rabies is completely preventable with a vaccine that is far more sophisticated than the multiple painful inoculations of the past.

 Roby agreed.

"Talk to your kids about any kind of animal scratching or biting them. The shots don't hurt. They're a little expensive — but not half as expensive as having a loved one go through this."

UC Davis Children's Hospital is the Sacramento region's only comprehensive hospital nationally ranked by U.S. News and World Report. It serves children, serving infants, children, adolescents and young adults with primary, subspecialty and critical-care services and includes the Central Valley's only pediatric emergency department and level I pediatric trauma center, which offers the highest level of care for critically ill children. The 110-bed "hospital within a hospital" includes a 49-bed, state-of-the-art neonatal intensive care unit and a 16-bed pediatric intensive care unit. With more than 120 physicians in 33 subspecialties, UC Davis Children's Hospital has more than 74,000 clinic and hospital visits and 13,000 emergency department visits each year. For more information, visitchildren.ucdavis.edu.

Vacuna contra el dengue de Sanofi se muestra "prometedora"

Viernes 10 de junio de 2011

Por Thin Lei Win

BANGKOK (Reuters) - El primer ensayo del mundo sobre la vacuna contra la fiebre del dengue desarrollada por el laboratorio Sanofi Pasteur, y que se lanzaría en el 2014, ha mostrado resultados "muy prometedores" en Tailandia, según informó el viernes un especialista involucrado en las pruebas.

La enfermedad transmitida por mosquitos es una amenaza para casi la mitad de la población mundial.De las 220 millones de personas que se estima que se infectan cada año, 2 millones desarrolla una forma severa de la condición conocida como fiebre hemorrágica del dengue, en su mayoría niños de América latina y Asia.

Los resultados iniciales del estudio realizado en Tailandia, que es uno de los 15 países incluidos en el ensayo clínico más amplio llevado a cabo por la división de vacunas de Sanofi-Aventis, no serán anunciados hasta fin del próximo año.El ensayo tailandés, que comenzó en el 2009, incluyó a 4.000 niños y mostró avances en sus primeros dos años. Ninguno de los participantes experimentó reacciones adversas graves a la vacuna.

"Es muy prometedor. La vacuna ha demostrado ser segura", dijo Arunee Sabcharoen, profesor emérito de pediatría tropical de la Universidad Mahidol de Bangkok y principal investigador de los exámenes tailandeses.El estudio de cuatro años de duración se está realizado en la provincia de Ratchaburi, 100 kilómetros al oeste de Bangkok. La vacuna se administró a niños de entre 4 y 11 años en tres dosis con seis meses de intervalo entre cada una de ellas.

"Observamos a los niños muy de cerca", dijo Arunee. "Ninguno de ellos presenta reacciones muy serias vinculadas con la vacuna", añadió.   La rápida urbanización y el constante movimiento de personas contribuyeron a la expansión del dengue a nuevas partes del mundo.

Arunee señaló que unas 70.000 personas padecen fiebre del dengue cada año en Tailandia, que destina anualmente unos 8,2 millones de dólares al tratamiento de la enfermedad y más de 26 millones de dólares al control de los mosquitos.

Actualmente no existe cura ni vacuna para la fiebre del dengue.Sanofi es el primer laboratorio en llegar a desarrollar ensayos en etapa final sobre una inmunización contra la dolencia. La compañía informó en el 2009 que destinaría 350 millones de euros (480 millones de dólares) a la construcción de un sitio para producir unas 100 millones de dosis anuales.

El jefe del programa de Sanofi para la vacuna contra el dengue, Jean Lang, dijo a Reuters que tres dosis de la inmunización -quizá con alguna otra de refuerzo más adelante- brindarían protección de por vida.

"Aquí nuestro objetivo es prevenir el dengue, brindar (la vacuna) como parte de un programa de inmunización (...) para que los niños estén protegidos ante las amplias epidemias que ocurren actualmente con frecuencia", añadió Lang.

(Editado en español por Ana Laura Mitidieri) Enviado por Dr. Juan Antonio Montaño Hirose

Babesiose - Zoonose emergente

ACTUALIDAD

¿Cuál es el estatus de la babesiosis en perros y gatos?

Babesia afecta a numerosas especies de mamíferos y al hombre

Por Joaquín Ventura García

Última actualización 01/06/2011@10:39:21 GMT+1

Babesia microti. (Foto: CDC)

Varias especies de Babesia son capaces de afectar a perros y gatos, transmitidas por garrapatas y en el caso de B. gibsoni incluso sin necesidad de vectores. El hombre también puede resultar infectado por estos parásitos sanguíneos, de hecho, ya se está calificando la babesiosis como una zoonosis emergente.

Un estudio* publicado en Veterinary Parasitology en abril explica en qué situación se encuentra actualmente Babesia en todo el mundo, concretamente las especies del parásito que afectan a perros y gatos. El equipo que ha llevado a cabo la investigación pertenece al Royal Veterinary College de Londres (Reino Unido).

La babesiosis es una zoonosis emergente. Se trata de una enfermedad transmitida por garrapatas, cuya especie varía según la especie de parásito y la zona del mundo en que se localice. La babesiosis canina está producida por diversas especies de Babesia, tiene distribución mundial e importancia clínica significativa.

Tiempo atrás, las especies de babesias que infectaban a los perros se diferenciaban simplemente por la observación al microscopio. Se consideraba que B. canis era una especie de mayor tamaño y B. gibsoni, más pequeña. Pero los métodos de diagnóstico molecular demostraron que existían más especies del parásito, como B. conradae o B. microti, que producían distintos cuadros clínicos.

Por otra parte, B. rossi y B. vogeli eran consideradas en un principio subespecies debido a que morfológicamente eran iguales, pero después se ha comprobado que son especies diferentes, con cuadros clínicos distintos, vectores diferenciados y sus propias características genéticas y de distribución geográfica.

Precisamente la distribución geográfica de las diversas especies de babesia ha determinado que cada una tenga uno o varios vectores de mayor importancia, que coinciden con las garrapatas habituales en las áreas en las que se encuentran. Excepción hecha de B. gibsoni, ya que se ha comprobado que puede transmitirse de perro a perro, por ejemplo en animales de pelea, sin necesidad de las garrapatas.

En cualquier caso, debido a su actividad zoonótica, la investigación de la prevalencia, características clinicopatológicas y epidemiología de Babesia es una cuestión de interés médico.

Los gatos sufren babesiosis en mucha menor medida que los perros. La mayor parte de los casos en felinos domésticos se han registrado en el sur de África, debidos a B. felis, una especie de pequeño tamaño que produce anemia e intericia como síntomas más característicos. B. cati ha sido detectada en India y también se han registrado casos esporádicos de babesiosis felina en Europa e Israel, producidos por B. canis, y en Tailandia, por B. vogeli.

Tratamiento de Babesia 

La babesiosis producida por las especies del parásito de mayor tamaño se suele tratar con dipropionato de imidocarb, con una buena respuesta clínica, mientras que las especies más pequeñas son más resistentes a la terapia. A menudo, no se produce una total curación cuando las infecciones están producidas por estas especies de pequeño tamaño: con frecuencia se dan recidivas.

El espectro de parásitos de la especie Babesia que afectan a perros y gatos se va ampliando gradualmente con la ayuda de las técnicas de diagnóstico molecular y una investigación clínica meticulosa. La detección precisa de las especies del parásito en cada caso es muy importante para la elección correcta de la terapia y un pronóstico lo más acertado posible.

*Solano-Gallego L, Baneth G. Babesiosis in dogs and cats-Expanding parasitological and clinical spectra. Vet Parasitol. 2011 Apr 19

Rabies Survivor: Girl from USA

Willow Creek girl becomes one of the few who’ve ever lived through the deadly virus

(MAY 26, 2011)  It started with a stomachache. Eight-year-old Precious Reynolds, who lives in Willow Creek with her grandparents, three siblings and a cousin, had been complaining about tummy troubles, so her grandpa took her to the local clinic. Assuming she had the flu, her doctor advised the usual treatment — rest, fluids — and sent her home.

Soon, new symptoms began to appear. Around 3 in the morning on Saturday April 30, Precious woke her grandparents complaining that her neck and back were hurting. “I thought she might have just slept on it wrong, so I told her to go back and lay down,” her grandmother, Shirley Roby, told the Journal by phone Tuesday. Come daylight, however, Precious wasn’t any better, so her grandpa drove her over the hill to Mad River Hospital.

Doctors performed tests but, given her stomachache and muscle soreness, they, too, assumed Precious had the flu. Once again her grandpa brought her home. “At lunch time, I was fixing all the kids lunch, and [Precious] said she felt like she was gonna get sick to her stomach,” Roby recalled. “She got up from the table and her legs just collapsed on her. She looked at me surprised. She just wasn’t functioning right.”

The family helped Precious to the couch, and over the next few hours they kept offering her water. But every time Precious took a sip she would vomit it back up. By 8 p.m. she couldn’t talk and was barely moving. Around 10 p.m. Roby tried to prop Precious upright on the couch, but she immediately slumped over, “like she was paralyzed.” That’s when Roby knew something was seriously wrong. “I said, ‘This is no damn flu.’”

Indeed it wasn’t. The following morning, Precious was flown 200 miles south to the U.C. Davis Medical Center where, almost a week later, doctors determined that she’d been infected with rabies.

Human rabies cases have become exceedingly rare in the United States, thanks in large part to vaccinations of domestic animals. The most recent human case in California was nine years ago, according to the California Department of Public Health (CDPH). Precious’ case is the first from Humboldt County.

The viral disease affects the central nervous system and is typically transmitted to humans from the bite of a rabid animal (bats and skunks are most common, though any mammal can contract the disease). After infection, symptoms can appear in as little as nine days, or they can take a year or more to show up. At first these symptoms are typical of many illnesses — fever, headache, general malaise — but as the disease progresses it starts to cause neurological problems. These vary dramatically from case to case, but they can include insomnia, anxiety, confusion, fear of water, partial paralysis, difficulty swallowing, hallucinations and more. Once these symptoms appear, death from respiratory failure is usually imminent.

“Up until a few years ago we would have said quite definitively that rabies is 100 percent fatal,” said Dr. Curtis Fritz, a public health veterinarian with the CDPH. The first human ever to survive rabies without a vaccination was a Wisconsin teenager named Jeanna Giese. The 15-year-old made worldwide headlines in 2004 after doctors saved her life by medically inducing a coma to protect the brain while her body fought off the virus. This method, which came to be called the Milwaukee protocol, is exactly what doctors at U.C. Davis used to save Precious.

 When she arrived at the hospital on May 1 she was already in critical condition, Roby said. According to Dr. Fritz, rabies is difficult to diagnose in living patients. Typically the disease is identified using a brain sample. “Obviously we can’t do that in a living patient,” Fritz said. Alternative measures involve looking for antibodies in the blood, cerebral-spinal fluid, saliva or corneal tissue (from the eyeball).

Though Precious had never mentioned being bitten by an animal, one of her doctors suspected rabies and called for the tests. (Later, Precious’ friends and siblings said they’d seen Precious playing with feral cats near her school.) The U.S. Centers for Disease Control confirmed the rabies diagnosis on May 6.

“She was fighting for her life right then and there,” Roby said. Even after the diagnosis, the doctors were pessimistic. They warned Roby and the rest of Precious’ family to expect the worst. “I was scared,” Roby admitted, her voice quivering. “I thought I was gonna lose her. I had never been around anything like this, but I knew she was a fighter.”

Literally, as a matter of fact; Precious loves athletics — wrestling in particular. Three years ago, Roby and her husband took guardianship of Precious, along with her sister and two brothers. The kids’ dad had warrants out for his arrest, and both parents were on drugs. As if that wasn’t enough, Precious has had a heart condition since birth — Supraventricular tachycardia, which sometimes makes her heart beat exceedingly fast, 260-280 times per minute. Yet through all this, Precious has remained outgoing and happy. “She’s one tough little cookie,” Roby said.

And so, despite the doctor’s warnings, Roby put her trust in her granddaughter’s resilient spirit. “Every day grandma would tell her, I’d say, ‘Precious, you got a bad bug inside of you.’ I’d say, ‘I want you to take him, throw him down, put him in a half-nelson, flip him over, get on his chest and smash him into that mat.’ I don’t know if that’s part of what brought her back or not, but we were fighting.”

Finally, doctors brought Precious out of her coma, and according to Roby, they’ve been simply amazed at the speed of her recovery. How do they explain it? “They can’t,” Roby said. “They said she has written a new chapter in the book.” Precious is now the seventh patient in the world to survive rabies, doctors told Roby, and nobody has progressed faster. Monday night she was moved from intensive care to pediatrics, and she’s speaking again — albeit in a whisper. Roby expects that her granddaughter will be ready to come home before too long.

The most important thing people can take away from this, Roby said, is to learn about the dangers associated with rabies so they don’t have to go through what Precious and her family have been through: Have your pets vaccinated, avoid contact with wildlife, and if you do get bit or scratched, treat the wound thoroughly and notify your doctor.

http://www.northcoastjournal.com/news/2011/05/26/rabies-survivor/