Rabies: 9 years and things are not getting better


 rabid dog
For about nine years now, I have been traveling to Baltimore on a semi-annual basis. I go to the Johns Hopkins Bloomberg School of Public Health and deliver, more or less, the same talk, year after year,  about rabies.
9 years, and more deaths.
It’s part of the vector-borne section of the course. While not a vector-borne disease (unless we wish to think of dogs as a vector between us and bats–a bit of a stretch, if you ask me), rabies is considered one of the Neglected Tropical Diseases (NTDs), and because it’s a preventable cause of horrific and needless suffering it needs to be somewhere.
Opening Salvo
I always preface my talk with two informal survey questions:
  1. Does anyone know what the OIE is?
  2. Does anyone know what One Health is?
Answers:
  1. OIE stands for Office International des Epizooties, or World Organisation for Animal Health (yes, they use the British spelling of “organization, which I think is a political statement, but that’s another post). It’s kind of like the WHO for animals, and it is based in Paris.
  2. One Health is a concept advanced by the American Veterinary Medical Association, the CDC, and other organizations. The CDC states “One Health recognizes that the health of people is connected to the health of animals and the environment. The goal of One Health is to encourage the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment.”
I think that over the years, I’ve had maybe three ‘yes’ answers to these questions, combined. The conclusions are obvious:
  1. The OIE is failing in its mission to educate the other health professions, as well as the general public, on the importance of animal health, both as it relates to animals alone and to human health as well.
  2. The One Health concept is a failed attempt by the veterinary profession to assert its presence into discussions of public health. It represents the profession’s inability to move itself from the general world of agriculture (where it is also clearly important) and place itself among the disciplines of other health sciences.
(As a veterinarian, we are used to being the red headed stepchild of the medical professions, so this doesn’t really surprise or irk me. Sometimes, we even create brilliant concepts, like One Health, so we can pretend that it’s really a thing for those outside of our bubble.)
So, what’s the problem here, specifically regarding rabies?
Let me preface this by saying that , I don’t really trust rabies statistics. The latest updates I’m reading estimate the annual number of rabies deaths at 59,000.  Given that most of these deaths come from rural areas in Africa and Asia with poor access to treatment and prevention, I’m not sure how they come up with that number. (On my to-do list: contact a rabies epidemiologist.) What I do know is that when I first started giving the talk, the number was 25,000 – 50,000. The range itself, varying by 100% of the low number, inspires doubt in and of itself.
That noted, the trend over the past nine years is at best level, and at worst shows an increase of 18%. Rabies does not get a lot of attention. Most diseases of the poor—Chagas’ disease, cysticercosis, leishmaniasis, hydatid disease, and others—get little attention. AIDS/HIV, tuberculosis, and malaria are the exceptions, but two of those are not restricted to poor areas overseas. Rabies kills “only” 59,000 people a year, a number that pales in comparison to the other diseases listed here. But working on one disease does not preclude working on another.  Rabies is low hanging fruit. The numbers of rabies deaths are skewed towards children.  Rabies is not a medical mystery. The bottom line is that no one should die the horrible death that comes with rabies infection.

 

Parasite Attack! Flesh-eating Worms in the United States!


 

A Meta-Bug News Roundup

Screwworms in Florida

The New World screwworm, Cochliomyia homnivorax, isn’t probably something you think about. Fortunately, you don’t have to. The screwworm, a larval form of a fly, has been eradicated in the United States since 1982.

220px-Cochliomyia_hominivorax_(Coquerel,_1858)220px-Screwworm_larva

Unlike maggots, which eat only dead flesh, the screwworm eats live tissue. When I was in Haiti recently, I saw what they are capable of. Any wound, any abrasion, any cut is an invitation for the flies to show up. Then the larvae come out, and work their way not just into the necrotic parts, but the actual live tissue.

Screwworms obviously present a serious danger to livestock. I can even find you a gross story where they went into a woman’s ear. But since the ’50s, researchers began experimenting with the release of sterile male flies, first on the relatively controlled setting of an island, and then on the mainland. By 1982, there were no more screwworms in the US.

Naturally, flies don’t recognize international borders, so in partnership with Mexico and the nations of Central America, the screwworm has been restricted to south of the isthmus of Panama, a bottleneck that is relatively easy to defend. The breeding of sterile males is ongoing in Panama.

Recently, 40 endangered Key Deer had to be euthanized in Florida when it was discovered that they were infested with screwworms. Sterile males were introduced, the Florida Department of Agriculture set up inspection stations in Key Largo for animals leaving the keys, and the outbreak was contained.

 

Robert Pirsig, author of Zen and the Art of Motorcycle Maintenance, has died.

“When one person suffers from a delusion, it is called insanity. When many people suffer from a delusion it is called a Religion.”

pirsig

Here’s a passage  from Zen  that I always found interesting.

Things are getting worse.

Twittler has proposed huge tax cuts, and naturally they benefit him and those in high income brackets the most. They propose eliminating the inheritance tax, which is probably the best tax we have: WE’RE TAXING DEAD RICH PEOPLE! They’re decomposing, they can’t complain, and if their whiny little offspring think it’s just horrible that they have to be just a tiny bit like the rest of us (which they won’t, they’ll still be stinking rich), well, they can commiserate in their gated communities and in their country clubs, just like they always have. The Great Unwashed will be able to perhaps feed and educate their children a little better. It’s understandable how those at the top don’t really want a level playing field, but keeping the “Paris Hilton” tax–or maybe we should call it the Trump Kids Tax–is a good thing. Just ask Teddy Roosevelt. Whatever you name it, don’t let anyone get away with calling it a “death tax.” It’s not.  It’s a tax on plutocracy and oligarchy.

I can’t write anymore today. A buffoon is fucking up or determined to fuck up so many things at once–relations with Canada and Mexico, military policy, health care, foreign trade– that it’s overwhelming. As I’ve written before, there’s a good chance that the American Experiment has failed, and the wise will at least be keeping an eye open on an exit strategy. While I’m here, I will work to make this a better and safer place, but I do not believe that this is the best place for my children to plan their future in.

Shavuah Tov. Impeach Drumpf.


Marched for science today. We all got together and spent over four hours outside on a ridiculously cold and drizzly late April day agreeing that we like science, that we are sorry that the current administration doesn’t, and that we wish that would change. The only hope that anyone saw was that Tangerine Jesus might get a chronic disease for which there is no cure, in which case he might fund research for it. It wouldn’t cover much, but it’s a start.dog protester

I was there with a street band, and I have to admit that if you’re gonna protest, it’s more fun playing music than it is listening to speeches.  Google “march for science signs” if you’re in need of a laugh.

Shavuah Tov. Impeach Drumpf.


Back to the workaday world.

Just a few links about our ever-crumbling separation of Church and State. And I do mean Church, because it ain’t gonna be synagogues, mosques, or temples.

This from the Washington Post on repealing of the ‘Johnson Amendment, ‘ which would allow tax-exempt houses of worship to become mouthpieces for politicians.

 

And this from New York Magazine on the devout Christian physician

14-willie-parker.w710.h473.2x
Dr. Willie Parker, AP photo.

who travels the South performing abortions for women who need them, which he feels is a moral obligation.

(Social) Media Shabbat


Did we forget about the Wall?  What about Jared Kushner deciding that Keter Shem Tov doesn’t mean shit to him?keter What about the fact that Trey Gowdy is worried about leakers when he lives in one of the most poorly educated districts in the country ? (I should know, I lived there) What about the horrible retrogressive AHCA? Everybody fucking hates it, except for a few idiots, but Twittler says pass it or I’m going to be moving on, my attention span on this subject is spent, and I don’t have the patience for real negotiation. What about the fact that there is a sizable part of the country that hates other Americans so much that they will give Der GropenFührer a pass on everything? What about the Israeli teen that is responsible for the bomb threats at the JCCs, giving more ammo to the already emboldened white supremacists? I can’t take it!

My Brain Hurts!

keter shem tov

See you tomorrow evening.

Lazy Journalism Day: Aggregating stuff you prob’ly read anyway.


 

Bug_aggregation
Pentatomid bud nymphs aggregating on a plant in Bangalore, India. Photo by L. Shyamal and taken from Wikipedia

I’m occupied with other things today, but there’s always time to make it look like I’m  actually paying attention.

These things seemed worth reading today:

From the NY Times, on feminism’s embrace of anti-Zionism–which although they will scream to the heavens that it isn’t, indeed is actually a form of anti-Semitism–and the bind that it puts Jewish feminists in;

From the Atlantic, on why being poor in Bangladesh might be better than being poor in Mississippi;

This, from Vox.com on the Republicans’ plan to make us get sicker and die faster;

And this, about our increasing military involvement in Iraq and Syria.

 

Depression in Teenage Girls and Young Women: Is it getting worse?


menace-1-1
From Hyperbole and a Half, a great blog on depression

 

Yes, that does seem to be the case, in spite of increased awareness, better medications, and supposedly less stigma.

This from NPR

This from MarketWatch

And this from the peer-reviewed journal Pediatrics

RESULTS: The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.

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