(from a discussion of two patients who completed rabies vaccination series after dog bites and yet developed rabies - m.)
…”There are government registered rabies vaccination centres in India where the vaccine administered would be genuine. But vaccines bought in a pharmacy might not be genuine or be inactive.
"About 15 years ago when I was running a virology diagnostic service in a London hospital we had a young man from London who had been bitten by a dog he never caught at a temple in a large city in India. He went to a government run clinic for rabies vaccination and had his 1st dose. He decided to continue his travels and bought subsequent doses at urban pharmacies on the days he was designated to have his course of vaccine so he completed it whilst on his travels.
He returned to London and wondered whether he might still get rabies and whether he responded to the vaccine. The Public Health Laboratory Service at Colindale requested a blood sample and did antibody titres to rabies. The result was the lowest possible level of antibody where it could be said to be positive… The only explanation was that the 1st dose of vaccine had raised this just-detectable level of antibody but the remaining vaccine shots he had bought from pharmacies was inactive, the equivalent of pink water!”
Rob Stein, WashPost: What is the biggest challenge facing the agency?
Thomas Frieden, CDC director: CDC’s budget was cut by $740 million between fiscal ’10 and fiscal ’11. That’s an 11 percent reduction in our budget authority and the lowest budget authority CDC has had since fiscal 2003. We’ve had to make very difficult and painful choices that are resulting in program reductions and eliminations, reduction in the number of staff working on projects, reductions in dollars going out to state governments for prevention, for preparedness, for lead poisoning prevention, for asthma management.
State and local governments have had to cut about 45,000 public health jobs in the past two years, and the CDC budget cuts may require them to reduce staffing by another 1,000 staff. So this, to me, is the biggest challenge.
Independent (UK) on ag antibiotics. No new news, important placement
The Independent (UK) has a major suite of stories this morning on antibiotic overuse in farming. (I can only see it on the web but people on the ground say the dead-tree version used its entire pp.1, 2 and 3.) Reading them, there is nothing in them that people who care about this issue will not already know (“threatens human health,” “pursuit of cheap protein,” “market forces,” “intensive farming”). But it’s significant that a major paper made the commitment to devote so much real estate to the issue.
CHOLERA - USA: (NEW YORK): REQUEST FOR INFORMATION
ProMED-mail is a program of the International Society for Infectious Diseases
Date: Thu 16 Jun 2011
From: Larry Lutwick MD, ProMED Bacterial Disease Moderator
On 12 Jun 2011, a 63-year-old insulin-dependent diabetic, African-American male was admitted to one of our affiliated hospitals [in Brooklyn, NY] with profuse, watery diarrhea for 4 days without vomiting, fever, blood in the stool or substantial abdominal pain.
He had purchased clams at a store in Brooklyn, NY and ate them on 6 and 7 Jun 2011. His wife did not eat the clams and did not become ill when the patient did on 8 Jun 2011. The clams were said to have been cooked, but neither the methodology of the cooking nor whether the cooked clams were exposed to the pre-cooked container are clear.
There was no travel history, no exposure to individuals from Haiti, the Dominican Republic or Germany or exposure to pets.
He had been treated for _H. pylori_ gastritis in mid-March 2011 with a regimen containing amoxicillin and clarithromycin for 2 weeks, which ended 6 weeks prior to the illness.
He was non-febrile with a normal blood count but had a serum creatinine of 3.9 mg/dL. He continued to have prominent watery, green colored diarrhea without blood or mucus at a rate of 4-6 L/day and was hospitalized in the ICU for aggressive fluid and electrolyte resuscitation.
Initially, a PCR for _C. difficile_ toxin was positive, and he was begun on oral vancomycin but had no evidence of colitis on CT scan.
The sheer amount of watery diarrhea, especially in a patient with questionably adequately cooked clams, made the infectious diseases consultant suspect a cholera or cholera-like disease. Stool culture revealed a curved-shaped Gram negative bacillus which was identified biochemically as _Vibrio cholerae_. O type is pending.
No other similar cases are known to the Department of Health…
Patients who say they’ve suffered severe adverse reactions to a common antibiotic are calling for action to prevent others from experiencing a ‘frightening’ number of alleged physical and mental side effects.
The victims, who say they were poisoned by ciprofloxacin, want more research into the drug’s side effects, greater education of health professionals and clearer warnings for consumers.
The calls come as an Ecologist investigation revealed the antibiotic has been linked to more than forty deaths in the UK in recent years, and been the subject of hundreds of suspected adverse reactions…
…Robinson argues more research needs carrying out into the side effects of ciprofloxacin and in the meantime says warnings with all fluoroquinolones should be made more prominent, as in the US.
He also says he believes that residues of fluoroquinolines in meat he has consumed may have caused his reactions to flare up significantly, raising concerns over the possible health implications of treating livestock with antibiotics…