The NYC Subway: Plague & Anthrax, but not Urine, Free

I often tell people that bacteria are everywhere, because they are. They lurk in almost every niche of the planet, including all the niches in and on our bodies. Some are found in more abundance in certain environments such as fresh water, salt water, on reptiles, in the soil, etc. 

So, when a study reported all the myriad microbes found in the NYC subway, I wasn't surprised as it as a perfect Petri dish for many different microbes because many people traverse it, it is littered with discarded food and often has puddles of liquid (which could be rain water on a good day, urine or some other substance on a bad day). Plus, rodents abound. 

The controversial part of the study, which detailed many different microbes being present, was the researchers detection of the bacteria that cause plague and anthrax in the subway. Such a finding immediately grabbed headlines. I also didn't find this to be too surprising because it is well known that both Bacillus anthracis and Yersinia pestis are widely distributed in the enviroment--though Y.pestis tends to stay west of the "plague line".  

The study was back in the headlines earlier this week when the research time clarified their findings, which now exclude the detection of the plague and anthrax bacilli in the subway. 

I would caution people--and rats--to not breath too deep a sigh of relief in the subway as, though not at risk for plague or anthrax, the smell of urine might do you in. 

Rumbling with Legionnaire's Disease in the Bronx

The attention rightly given the Bronx Legionnaire's Disease outbreak is interesting to me as a Pittsburgher where Legionella pneumophilia is in the water, quite literally. Almost monthly a Pittsburgh news outlet reports of Legionella being found in a water source, including those fountains at shopping malls and parks. We recently experienced a deadly Legionnaire's Disease outbreak that evolved into a full-fledged scandal at the Pittsburgh VA hospital that even President Obama took note of.

The important points to keep in mind about Legionnaire's Disease are:

• It is nothing new. Legionnaire's Disease was first described in 1976 and retrospectively tied to earlier outbreaks. 
• Legionella bacteria are a natural inhabitant of water--even rain puddles--where they live within amoeba.
• Legionnaire's Disease is quite common, comprising up to 5% of ordinary community-acquired pneumonias. It tends to infect older individuals with other medical conditions and is not communicable between people.
• Hugh Hefner had to think about it!

The Bronx outbreak underscores the need to think about water sources for buildings and whether they have been adequately maintained and disinfected at regular intervals, if not this is what occurs. The trajectory of the current NYC outbreak--there is a separate cluster at West Chester University in Pennsylvania--will likely end as cases are diagnosed and the common source water is treated. 

Infectious diseases are legion and Legionnaire's Disease is just another member of the pack that is easily tamed.

If it Doesn't Fit, You Must Acquit: Decoding Canine Fecal Crimes

I don't mean to be continuing on the theme of feces (it seems to be a topic many are interested in) but some new developments are not ignorable. 

When people talk about the role of genomics, next generation sequencing, and personalized/precision medicine it is often in the context of improving human health. Undoubtedly, these technologies have broader applications and have revolutionized forensic science, for example.

The newest application seems to be just as an innovative as the mainstream applications. While you might think it might involve creating hybrid creatures, understanding dinosaurs, or looking for life on asteroids it is much more this-worldly and is so down to earth you've probably had it on the bottom of your shoe a few times. 

The new application is the genetic sequencing of dog poop to determine whose animal emitted it. The company that performs this very vital service is aptly named PooPrints.

This development reminds us that, amongst all the blind alleys science may lead us down if, in the darkness, we step in something we can find the culpable party.

Civilization Is Avoiding Immersing Oneself in Feces

When it comes down to it, one of the major life-enhancing aspects of modern civilization is the fact that it has removed a lot of poop from our daily life. For most of humanity's existence people's hygienic habits were, in some respects, a little gross. When humans were all just hunter-gathers who nomadically moved around, sanitation took care of itself as people did not literally sit in their own stuff. When agriculture and farming--unmitigated technological advances--were developed people become more stationary as they began growing crops and raising livestock. This scenario created a condition in which people lived amongst their own sewage.

Sanitation, outhouses, and plumbing, in essence, allow there to be some separation where a person ate, slept, and lived from where they did their...other business. Gone are the bed pans and cesspools that littered the cities of the 18th and 19th century in which being a "night soil man" was a real career.

Now, anytime we hear of a raw sewage exposure in a, for example, recreational waterway it is major news. The 21st Century human has no tolerance for a feces-filled life (though we still are exposed to feces in everyday life all the time, just much more surreptitiously).

However, the world's elite athletes are literally poised to be swimming in it, quite literally, if Rio's waterways remain as feces-ridden as they currently are at the time of the Olympics. Viral counts are extremely high in some of the waters tested.

In prior Olympics blood-doping involved increasing the oxygen delivery capacity of the blood, in 2016 a blood-doper will be someone whose blood carries the requisite antibodies and levels of antibiotics to excel in a river of poop.

The Availability Heuristic, Vaccines, and Keeping Children Safe

"I just want to be safe."

That's what a mother of an infant told me today after she brought her child to the emergency department after he possibly ingested some glass from kitchenware he broke. Today was one of the days I do a shift in the ED in order to keep my emergency medicine skills and knowledge base active (I originally trained in both internal and emergency medicine before embarking on fellowships in infectious disease and critical care medicine).

Thankfully, the child didn't ingest any glass. But that's not why I'm writing about this incident. The reason I am writing about this is because the mother has delayed vaccination for her child, something that is unequivocally not safe. 

I find it hard to fathom that while a glass ingestion is correctly thought of as a clear and present danger to her child, vaccine-preventable illnesses--which kill incalculably more children than glass ingestions ever could--doesn't register the same sense of alarm in this mother.

The only explanation I can come up with is a serious threat misperception akin to fearing shark attacks but not drowning in the neighborhood pool--something that has to do with what is known as an availability heuristic coupled with the ability to imagine a horrible outcome. In this example, it is not hard for a mother to imagine her child ingesting glass and having a horrible outcome while it may be harder for her to imagine her child contracting a disease made rare because of the success of vaccines. 

This explanation carries some weight as we see the availability heuristic working for the vaccine cause after the Disneyland measles outbreak made it much easier for parents to imagine their child contracting measles and thus the increased support for vaccines.

I wish this mother realized that vaccines--as well as a broken glass free environment--are a crucial measure needed to keep her child safe .