TIME Infectious Disease

How an HIV Outbreak Hit the Heartland

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom—TIME

Drug abuse combined with a spotty public health system are to blame for Indiana's public health emergency

Indiana Governor Mike Pence on Thursday declared a public health emergency in a rural Indiana county after 79 cases of HIV were confirmed there in the last several months.

An outbreak of HIV may seem odd in such a remote part of the country. The dozens of confirmed cases, described as an epidemic, are centered in Scott County, about a half-hour north of Louisville with a population of about 25,000.

But the spike has been fueled by growing heroin and drug use in rural counties like this one. A number of Midwestern states have struggled with a recent uptick in drug and needle use, and Indiana specifically has seen an increase in the use of a powerful painkiller called Opana, which can be altered and injected. The number of deaths related to opioids like Opana rose from 200 a year in 2002 to 700 in 2012, according to the Indiana State Department of Health.

In this area of the state, there’s relatively weak public health infrastructure to prevent the infection from spreading. Scott County is just one of five counties serviced by a single HIV testing clinic, and the county’s relative isolation from a sufficient public health system can help explain the virus’s rapid growth, says Beth Meyerson, an Indiana University health professor and co-director of the Rural Center for AIDS/STD Prevention.

“The system isn’t working and isn’t strong enough from a public health perspective,” Meyerson says.

In a 2013 study by the non-partisan organization Trust for America’s Health, Indiana ranked last in federal funding per capita from the Centers for Disease Control. The national average spent per capita was $19.54. In Indiana, $13.72 was spent on each Hoosier.

Indiana has also seen an increase in Hepatitis C in many rural communities, says Meyerson, another warning sign that HIV may be spreading. According to the U.S. Department of Health & Human Services, about 25% of people who have HIV in the U.S. are co-infected with Hepatitis C.

On Thursday, state authorities stepped in. Gov. Pence allowed local officials to start a 30-day needle-exchange program in Scott County as a way to stop the outbreak. “I do not enter this lightly,” Pence said, according to the Indianapolis Star. “In response to a public health emergency, I’m prepared to make an exception to my long-standing opposition to needle exchange programs.”

MORE: This Contraceptive is Linked to a Higher Risk of HIV

While dozens of cases have been reported, it’s likely that there are many more still unconfirmed. “I don’t expect these counties will remain the center of the epidemic,” Meyerson says. “I’m sure it’s going to be in other parts of southern Indiana, wherever our system is the weakest. We don’t know what we don’t know right now.”

TIME public health

Scathing Report Calls Lab Safety at CDC ‘Insufficient’

The Centers for Disease Control Buildings in Atlanta on June 20, 2014.
Tami Chappell – Reuters The Centers for Disease Control Buildings in Atlanta on June 20, 2014.

A new public report from outside experts assessing laboratory safety at the U.S. Centers for Disease Control and Prevention (CDC) comes down severely on the government agency.

In 2014 and early 2015, the CDC was the site of a series of mishaps, from a lab technician the agency thought was potentially exposed to live Ebola virus through an accidental tube swap to the possible release of anthrax. In response, the agency formed an external laboratory safety workgroup to assess the CDC’s internal protocols and provide advice and recommendations. The CDC just publically posted the report, which describes the CDC’s commitment to safety as “inconsistent and insufficient at multiple levels,” to its website.

“Safety is not integrated into strategic planning and is not currently part of the CDC culture, enterprise-wide,” the report says. “Interviews and surveys demonstrated that many employees neither understand the agency’s response to accidents nor how that information is communicated to the larger agency community outside immediately affected labs.”

The authors write that “disturbingly” many of these responses were among people who work in the CDC’s highest biosafety level labs. “Laboratory safety training is inadequate,” the report authors write, adding that across the CDC, workers say they fear negative repercussions for reporting instances where there may have been an exposure to hazardous material. Staff at the CDC view the Environment, Safety, and Health Compliance Office (ESHCO)—the office meant to protect CDC workers and create a safe working environment—as having “inadequate expertise” in lab safety, the report says.

The report makes recommendations, like “staffing [ESHCO] with scientists with professional qualifications in research and/or laboratory safety” and establishing consistent safety practices across the agency.

“CDC concurs with these recommendations, has made progress towards implementing them, and will soon report on that progress,” the CDC says in a statement on its website. “CDC’s aim is to improve the culture of laboratory safety across the agency and minimize the risks associated with laboratory work.”

“It should be noted that although the [workgroup] presented its findings to the full committee in January, it began its review of CDC’s laboratories last August and did the bulk of its assessment at CDC in August and September,” CDC spokesman Tom Skinner told TIME. “So the said report reflects observations of the workgroup made several months ago.”

Skinner the CDC has made progress, and is implementing actions to “address the root causes of recent incidents and to provide redundant safeguards across the agency.” Some of these changes include establishing new positions for lab safety oversight and implementing new training procedures and safety protocols.

TIME Infectious Disease

A New Blood Test Could Stop Doctors From Overprescribing Antibiotics

In this image provided by Duke University, lab research analyst Marshall Nichols does research relating to a new blood test on Tuesday, Sept. 17, 2013, in Durham, N.C.
Shawn Rocco—AP In this image provided by Duke University, lab-research analyst Marshall Nichols does research relating to a new blood test on Sept. 17, 2013, in Durham, N.C.

The procedure distinguishes between viral and bacterial infections

Scientists claim to have established a new blood test that can help doctors quickly distinguish between bacterial and viral infections, giving physicians the ability to prescribe antibiotics more accurately. That’s according to a study published by PLOS One on Wednesday.

Israeli-based company MeMed, along with researchers from other institutes, says that they examined over 1,000 patients and found that their ImmunoXpert blood test could distinguish between immune responses to bacterial or viral infections. The procedure is reportedly fast, taking only hours to complete when alternatives often require days.

“Antibiotic misuse is a pressing public health concern, with devastating healthcare and economic consequences,” stated MeMed CEO Eran Eden in a release to media. “Unlike most traditional diagnostics, this approach builds on an exquisitely informative system crafted by nature — the human immune system.”

While still in the laboratory stage, the test could be important because doctors have long struggled to identify the root causes of infections, meaning that antibiotics, which only attack bacteria, are often prescribed unnecessarily.

TIME Infectious Disease

27 People at Kansas High School Test Positive for Tuberculosis

More than 300 students and staff were tested for TB at the school

More than two dozen people at a high school in Kansas have tested positive for tuberculosis.

After about 300 students and staff at the school were tested, 27 of them, or 8%, were found to be infected with TB, according to the Kansas Department of Health and Environment.

The large number of instances of TB comes less than two weeks after one student at the school tested positive for the illness.

“The number of individuals with TB infection does not exceed what we would anticipate in this setting,” said Lougene Marsh, director of the Johnson County Department of Health and Environment. “Of course, we had hoped we wouldn’t find any additional TB cases, but we knew this was a possibility.”

None of the individuals who tested positive are showing symptoms of TB, meaning they do not have the disease, Marsh said. They are undergoing treatment to ensure their infections do not become sick.

In 2012, Kansas reported 42 people contracted TB disease.

TIME Infectious Disease

Parents Hunt for Answers on Kids’ Mysterious Paralysis

Mikell Sheehan Eight-year-old Bailey Sheehan was diagnosed with mysterious paralysis in October.

"Over 100 kids are paralyzed and no one’s talking about it"

In August 2014, a small number of children began turning up at emergency rooms around the country with symptoms of severe respiratory disease.

“Our hospital was overflowing,” recalls Dr. Sam Dominguez, a microbial epidemiologist at Children’s Hospital Colorado, in Aurora.

From the last week of August through the first three weeks of September, the hospital admitted 325 patients with respiratory symptoms, compared to an average of 130 during the same period the previous two years. “This disease was unprecedented for that time of the year,” says Dominguez.

Soon, it was discovered that many of the children were suffering from a specific strain of enterovirus: EV-D68. Many children who get enteroviruses have no symptoms at all; others develop what amounts to a nasty flu. But in this new outbreak, some kids were turning up with weak or paralyzed limbs, stumping doctors.

When the first case of sudden and unexplained partial-paralysis turned up at his hospital, Dominguez says the situation was unusual but not completely unheard of. Two weeks later, another child showed up with limb weakness and paralysis. The following week, there were four more cases. “We were very worried,” says Dominguez. The hospital called the health department and the Centers for Disease Control and Prevention (CDC) for insight.

The CDC reached out to public health authorities in other states and sure enough, states across the country were reporting bizarre cases of children coming in unable to move their limbs. From August 2014 to early March 2015, 115 children in 34 states have been diagnosed with what authorities are calling acute flaccid myelitis (AFM).

One of them is an 8-year-old named Bailey. Bailey’s mother, Mikell Sheehan, says that a few days after the family came down with what she describes as a bad cold, she discovered her daughter collapsed in the bathroom in their Oregon home, unable to move her leg.

In December, in California, Megan and Ryan Barr noticed their 6-year-old son Ryder was playing with only his left hand because his right arm felt funny. “It’s hard to explain to a six-year-old what’s happening to them,” says Megan.

One problem for doctors is that the sudden onset of paralysis among children, while rare, happens from time to time with other ailments, including West Nile or Guillain-Barré syndrome. Sorting between the possible causes—and deciphering what’s normal and what’s cause for concern—can be difficult, but experts agree this recent cluster is out of the ordinary.

“The short answer is yes, I think the cluster [of AFM] is connected,” says Dr. Jim Sejvar, a neuroepidemiologist with the CDC investigating AFM. “One of the challenges is there are a lot of different reasons kids can develop [sudden paralysis]. It’s a fruit salad. I think what we saw in the summer and fall of 2014, the vast majority of those children had the same thing. Whether it’s directly related to EV-D68, that’s the part we are trying to sort out.”

No Smoking Gun

Even more confounding to experts is the fact that no two cases are quite alike. Medical officials say a link between EV-D68 and AFM seems obvious, since the two upticks in cases occurred simultaneously. But while some of the paralyzed kids have tested positive for EV-D68, many haven’t. In January, the CDC reported that among 71 paralyzed patients who had their cerebrospinal fluid tested, not a single one was positive for enterovirus.

“The concurrence of EV-D68 and AFM is pretty difficult to ignore,” says Sejvar. “In the absence of any clear alternative, there is a suspicion that EV-D68 could potentially have played a role [in these cases of paralysis and limb weakness]. Unfortunately we don’t have the smoking gun that would allow us to say with absolute certainty that’s the case.”

An early attempt to establish diagnostic criteria for AFM was highly specific, with MRI images of lesions in the spinal chord being a requirement. But now experts worry that criteria set the bar higher than it should have been. “We know we are missing cases,” says Sejvar, who says MRI images can appear different based on when it’s taken. “It’s entirely consistent and possible that some children do have AFM, but for one reason or another were not meeting the CDC case definition that includes the MRI findings.”

While the CDC is still actively investigating what may have caused the recent cluster of AFM cases, it’s hit roadblocks. For instance, the agency developed an antibody test to see whether children with AFM were also more likely to have antibodies against EV-D68 compared to other healthy children. But the researchers discovered that nearly everyone in the general public has those antibodies, making the comparison useless to investigators.

Parents are looking for answers, too. A few days after Sheehan’s daughter was featured in a local news story, a woman named Erin Olivera, from Moorpark, California, sent her a friend request on Facebook. She said she’d gone through the same experience with her 3-year-old son Lucian in 2012. Though Lucian has slowly gained back some control over his legs since the initial onset, Olivera says he’s not “100%” and that she’s still looking for answers.

“I realize it’s frustrating to not have a definitive answer, particularly for parents,” says the CDC’s Sejvar. “We are working as hard as we can to establish the underlying cause.”

Parents Band Together

Together, Olivera and Sheehan created two Facebook support groups—one public, one for members—for families impacted by AFM. They launched the groups in January and now have about 90 members.

“We have a lot of polls going to see if we can figure out similarities,” says Sheehan. The patterns the women have noticed include: Most of the kids, their parents say, developed respiratory infections some time between August and December 2014, and shortly after that, their children had numbness, weakness or paralysis in one or more of their limbs. Many of the children were given steroids to treat their respiratory symptoms. Many had siblings who were also ill with a respiratory virus but had no paralysis. And many of the children have family members who have autoimmune diseases. (Some of these shared experiences are more substantiated than others.)

Some of the parents have signed up their kids for a clinical trial at Johns Hopkins that’s comparing the DNA of children with AFM who had an enterovirus infection to their siblings who also got sick but were not paralyzed. The researchers want to see if there are any genetic mutations that may make one child paralyzed and the other not.

Sheehan and Olivera plan to create a hub where science-based information about the disease can be easily shared by families facing similar situations. They hope growing awareness will encourage more attention for their children and the mysterious disorder. And just as much as the parents share research, they also share frustration. “There’s over 100 kids who are paralyzed and no one’s talking about it,’” says Megan Barr. “We are all kind of feeling around in the dark.”

Read next: Nearly Half a Million Babies Die From Poor Hygiene

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TIME Infectious Disease

Disneyland Measles Outbreak Linked to Places With Low Vaccination Rates

Measles California
Jae C. Hong—AP Sleeping Beauty's Castle is seen at Disneyland on Jan. 22, 2015, in Anaheim, Calif.

Poor vaccination rates may be to blame for recent measles outbreak

The areas hit by the recent measles outbreak had vaccination rates as low as 50%, which allowed the disease to spread, new research suggests.

Researchers at Boston Children’s Hospital analyzed case numbers reported by the California Department of Public Health as well as other regional surveillance data to estimate the vaccination rates of areas affected by the measles outbreak in California, Arizona and Illinois. The team published a research letter of their findings in the journal JAMA Pediatrics.

The researchers found that the vaccination rates for the areas were somewhere between 50% to 86%, which is significantly lower than the 96%-to-99% rate needed to create herd immunity — when a significant portion of the population is protected so that there’s a low risk of an infectious-disease outbreak.

“Our data tell us a very straightforward story — that the way to stop this and future measles outbreaks is through vaccination,” said study author John Brownstein, of the Children’s Hospital Informatics Program, in a statement. “The fundamental reason why we’re seeing the number of cases we are is inadequate vaccine coverage among the exposed.”

Between Jan. 1 to March 13, 176 Americans were infected with measles and reported to the U.S. Centers for Disease Control and Prevention. Most of the people in the recent outbreak were not vaccinated, and many of the cases were linked to a Disneyland amusement park in California.

TIME toxins

How Ice Cream Gets Contaminated—and Sometimes Kills

What could have caused 3 deaths in Kansas

Three people in Kansas have died after eating contaminated Blue Bell Creameries brand ice cream products. A total of five people were infected, and the ice cream has been recalled. But how does ice cream get tainted in the first place?

The bacteria that contaminated the ice cream is called Listeria monocytogenes, and according to the Centers for Disease Control and Prevention (CDC), about 1,600 Americans get sick from Listeria every year. It’s the third leading cause of death from food poisoning. It’s the same bacteria that contaminated caramel apples from California in January, causing 35 people in 12 states to get sick, and killing seven.

The bacteria grows very well at refrigerator temperatures, even as low as 40 degrees Fahrenheit. The Food and Drug Administration (FDA) says that the longer ready-to-eat refrigerated foods are stored in the fridge, the more opportunity the bacteria has to grow.

“It’s why it’s a problem for cooler foods like ice cream and cheese,” says Bill Marler, a food safety lawyer in Washington state.

MORE: 3 Kansas Patients Die From Tainted Ice Cream

The FDA was able to confirm that three strains of the bacteria came from a single Blue Bell production line at one facility in Brenham, Texas, though the agency has not disclosed a precise point of contact. Blue Bell says one of its machines produced the problem.

“Likely what happened is the piece of machinery was contaminated. The liquid form of the ice cream goes through the machine when it’s not yet frozen, but around 40 degrees, and it’s a great place for [listeria] to grow,” says Marler.

It’s not the first time contaminated ice cream has sickened Americans. In December 2014, Snoqualmie Gourmet Ice Cream, Inc. issued a voluntary recall of several of its ice cream, gelato, custard and sorbet products when they tested positive Listeria, and sickened two people. In 1994, 200,000 people became ill from eating Schwan’s ice cream that had been transported by a distribution truck that had previously transported non-pasteurized liquid eggs contaminated with Salmonella.

Other recent dairy outbreaks include a 2014 outbreak of Listeria in cheese and dairy products produced by Oasis Brands, Inc. Five people became ill and one died. A year earlier, six people were infected with Listeria in Crave Brothers Farmstead Cheese Company cheese products—one person died.

TIME Infectious Disease

3 Kansas Patients Die From Tainted Ice Cream

A total of five people were infected

Three people in Kansas have died after eating contaminated Blue Bell Creameries brand ice cream products, health officials said.

A total of five people in the state were infected with life-threatening listeriosis, which is caused by exposure to the bacteria Listeria monocytogenes. Four of the ill individuals told health authorities they drank milkshakes made with a Blue Bell brand ice cream product called “Scoops” in the last month.

MORE: Here’s What Foods Are Most Likely To Have E. Coli or Salmonella

The Centers for Disease Control and Prevention (CDC) says all of the individuals were being treated in the same hospital for unrelated conditions, suggesting they acquired the infections at the hospital.

The tainted products came from one Blue Bell production facility in Brenham, Texas, the Food and Drug Administration (FDA) said in a statement. The agency found three strains of the bacteria in Blue Bell Chocolate Chip Country Cookies, Great Divide Bars, Sour Pop Green Apple Bars, Cotton Candy Bars, Scoops, Vanilla Stick Slices, Almond Bars and No Sugar Added Moo Bars.

The CDC says Blue Bell has removed potentially contaminated products from the market, buy but that “contaminated ice cream products may still be in the freezers of consumers, institutions, and retailers.”

“One of our machines produced a limited amount of frozen snacks with a potential listeria problem,” Blue Bell said in a statement that noted it was the company’s first product recall in over a century. “When this was detected all products produced by this machine were withdrawn. Our Blue Bell team members recovered all involved products in stores and storage. This withdrawal in no way includes our half gallons, quarts, pints, cups, three gallon ice cream or the majority of take-home frozen snack novelties.”

TIME Infectious Disease

India’s Swine Flu Virus Is Becoming More Severe and Infectious, Study Says

The deadly virus has already infected more than 25,000 people across the South Asian nation

The swine flu outbreak in India that has already killed more than 1,400 people since December may be even more dangerous than previously thought, with a new study suggesting that the current strain of the disease’s parent H1N1 virus has mutated to become more virulent.

The study, conducted by two researchers from the Massachusetts Institute of Technology (MIT) and reported in Science Daily, contradicts claims by Indian health authorities that the virus has not mutated since 2009 — when it claimed over 18,000 lives worldwide over the subsequent three years.

Researchers Ram Sasisekharan and Kannan Tharakaraman compared the two influenza strains currently affecting the Indian population with the 2009 strain of H1N1 using their respective genetic sequences. They found mutations in the Indian strains in a protein called hemagglutinin, which binds with receptors on the human body’s respiratory cells. One of the mutations is linked to increased severity of the disease, while another enhances its infectiousness.

“The point we’re trying to make is that there is a real need for aggressive surveillance to ensure that the anxiety and hysteria are brought down and people are able to focus on what they really need to worry about,” said Sasisekharan.

Swine flu has been on the rise in India since December, having already infected more than 25,000 people.

TIME Infectious Disease

Superbug Found at Second L.A. Hospital

General View Of Cedars-Sinai Hospital Where Kim Kardashian Gave Birth To A Baby Girl
Frederick M. Brown—Getty Images General View of Cedars-Sinai Hospital on June 17, 2013 in Los Angeles, California.

An additional 64 may have been exposed at Cedars-Sinai

Four patients have been infected with a deadly superbug at Cedars-Sinai Medical Center in Los Angeles, the hospital said Wednesday, and an additional 64 may have been exposed.

Cedars-Sinai began investigating a possible link between CRE infections and one Olympus Corp. duodenoscope used from August to February of 2014 in a procedure called endoscopic retrograde cholangiopancreatography (ERCP), according to the Los Angeles Times. That involves putting a scope down a patient’s throat to diagnose and treat problems in the digestive tract, like gallstones and cancer; about 500,000 people undergo ERCP every year.

MORE: What You Need to Know About the California ‘Superbug’

A similar outbreak occurred at UCLA’s Ronald Reagan Medical Center in mid-February. There, five people were infected by medical scopes with CRE bacteria, and two of them died.

CRE, or carbapenem-resistant Enterobacteriaceae, kills up to half of those infected. One of the four patients at Cedars-Sinai has died, but the hospital said it was for an unrelated reason.

[Los Angeles Times]

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