September 23, 2022
2 min read
The mysterious pneumonia outbreak in Tucuman, Argentina, that I covered for Forbes yesterday, is not so mysterious any more. According to an update from the Pan American Health Organization (PAHO), the Argentina Ministry of Health has confirmed that Legionella bacteria is the cause of the outbreak that has now left 11 people ill and four dead.
Here’s a PAHO tweet with the update:
The update specifically mentioned Legionella pneumophila, which is one of a legion of different Legionella bacteria species that also includes L. longbeachae, L. feeleii, L. micdadei, and L. anisa. Legionella can hang out in amoebae that live in wet environments such as air conditioning systems, cooling towers, hot tubs, plumbing systems, humidifiers, ice-making machines, fountains, misting systems, whirlpool spas, ventilators, potting mixes, and composts. This is yet another reason why you shouldn’t shove potting mix or compost up your nose.
When the bacteria enters your lungs via your inhaling contaminated water droplets or soil, the result can be a milder illness called Pontiac Fever with symptoms developing a few hours to 3 days after exposure to the bacteria. Or a more severe illness, dubbed Legionnaire’s Disease, with symptoms developing two to 10 days after exposure. The severity of the illnesses in this outbreak suggests that it’s been an outbreak of Legionnaire’s Disease. It’s called Legionnaire’s Disease not because it will turn you into a Legionnaire and wear those hats that they wear. Instead, as I described for Forbes in 2018, it got its name from where the bacteria was first identified: at a three-day American Legion convention at the Bellevue-Stratford Hotel in Philadelphia, Pennsylvania, in 1976.
Not everyone exposed to the Legionella bacteria will end up getting ill. You are more likely to develop Legionnaire’s Disease if you have a weaker immune system (e.g., 50 years or older, have a chronic disease, or are on medications that suppress the immune system) or weaker lungs (e.g., suffering chronic obstructive pulmonary disease). That doesn’t mean that you should say, “bring it on,” to Legionella bacteria. Even if you are perfectly healthy, you can still get Legionnaire’s Disease, although the likelihood would be significantly less.
The key to treating Legionnaires’ disease is getting the right antibiotics as soon as possible. As the World Health Organization (WHO) relates, the overall death rate from Legionnaires’ disease is between 5 and 10%. However, this death rate can bounce up to 5 to 30% if you have a weaker immune system and even further up to 40 to 80% if you have don’t get proper treatment in time. That’s why doctors should look for evidence of Legionella in your urine, blood, or sputum as soon as should as Legionnaires’ disease is in any way suspected.
So the good news about this pneumonia outbreak in Tucuman, Argentina, is that it isn’t a oh-my-goodness-what-the-heck-is-going-on outbreak. Instead, it’s a oh-this-has-happened-before-such-as-in-Philadelphia-in-1976 outbreak. It also isn’t common for an infected person to transmit Legionella to another person, although there has been a documented case of that happening in the past. Therefore, the chances of Legionella spreading wildly in the population is very, very low. This certainly isn’t a situation where you should panic and start hoarding toilet paper. (In general, it’s unlikely that health authorities will ever say, “OK, everyone hoard toilet paper now.”) This Legionella outbreak is not the same as the Covid-19 pandemic situation. Or the monkeypox outbreak situation. In other words, this Legionella outbreak is not likely to spread far and wide.
That being said, authorities aren’t going to say something like YOLO and not continue to act with urgency. Now, they are trying to identify the source of the outbreak as soon as possible to prevent further people from getting sick. After all, you don’t want some water system to keep spraying Legionella into the air like a mist machine at a Phantom of the Opera show. The Argentina Ministry of Health and local health authorities have been collecting environmental samples in and around the private clinic in San Miguel de Tucumán in northwestern Argentina where the health care workers affected by the outbreak worked. This may help identify what needs a-fixing. They’ll want to make sure that there’s no more “airing” on the side of the Legionella bacteria.
The study by University of British Columbia researchers says that while reduced social interaction during the March-May 2020 lockdown worked to reduce HIV transmission, that may not have “outweighed” the increase caused by reduced access to services.
The study, published in Lancet Regional Health, found that fewer people started HIV antiretroviral therapy or undertook viral load testing under lockdown, while visits to overdose prevention services and safe consumption sites also decreased.
The overall number of new HIV diagnoses in B.C. continues a decades-long decline. But Dr. Jeffrey Joy, lead author of the report published on Friday, said he found a “surprising” spike in transmission among some drug users during lockdown.
Joy said transmission rates for such people had previously been fairly stable for about a decade.
“That’s because there’s been really good penetration of treatment and prevention services into those populations,” he said in an interview.
B.C. was a global leader in epidemic monitoring, which means the results are likely applicable elsewhere, Joy said.
“We are uniquely positioned to find these things,” he said. “The reason that I thought it was important to do this study and get it out there is (because) it’s probably happening everywhere, but other places don’t monitor their HIV epidemic in the same way that we do.”
Rachel Miller, a co-author of the report, said health authorities need to consider innovative solutions so the measures “put in place to address one health crisis don’t inadvertently exacerbate another.”
“These services are the front-line defence in the fight against HIV/AIDS. Many of them faced disruptions, closures, capacity limits and other challenges,” Miller said in a news release.
“Maintaining access and engagement with HIV services is absolutely essential to preventing regression in epidemic control and unnecessary harm.”
The Health Ministry did not immediately respond to requests for comment.
Researchers said the spike among “select groups” could be attributed to a combination of factors, including housing instability and diminished trust, increasing barriers for many people who normally receive HIV services.
British Columbia is set to become the first province in Canada to decriminalize the possession of small amounts of hard drugs in January, after receiving a temporary federal exemption in May.
Joy said this decision, alongside measures like safe supply and safe needle exchanges, will make a difference preventing similar issues in the future.
“The take-home message here is, in times of crisis and public health emergency or other crises, we need to support those really vulnerable populations more, not less,” he said.
“Minimally, we need to give them continuity and the access to their services that they depend on. Otherwise, it just leads to problems that can have long, long-term consequences.”
This report by The Canadian Press was first published Sept. 24, 2022.
© 2022 The Canadian Press
September 23, 2022
2 min read
One author reports receiving speaker and consultant fees from Bayer and Janssen for work unrelated to this study. Walli-Attaei and the other authors report no relevant financial disclosures.
The magnitude of associations with major CVD for most risk factors are similar in women and men, despite sex differences in risk factor levels, according to an analysis of the PURE study.
In a comprehensive overview of the prevalence of metabolic, behavioral and psychosocial risk factors for CVD in women and men globally, researchers also found that diet was more strongly associated with CVD in women than in men. However, high concentrations of non-HDL and related lipids and symptoms of depression were more strongly associated with risk for CVD in men than in women. Patterns remained consistent across countries regardless of income level.
“Existing studies, mostly from high-income countries, have reported that hypertension, diabetes, and smoking are more strongly associated with cardiovascular disease in women than in men,” Marjan Walli-Attaei, PhD, a research fellow at the Population Health Research Institute of McMaster University and Hamilton Health Sciences, and colleagues wrote in The Lancet. “Such findings would imply that women would benefit to a greater extent in reducing cardiovascular disease risk from control of these risk factors than would men. However, the burden of cardiovascular disease is greatest in low-income and middle-income countries, for which prospective data on the association of risk factors with cardiovascular disease are sparse, with a paucity of analysis by sex.”
Walli-Attaei and colleagues analyzed data from 155,724 adults aged 35 to 70 years at baseline without a history of CVD enrolled in the PURE study, which included participants from 21 high-, middle- and low-income countries, and followed them for approximately 10 years (58% women; mean baseline age, 50 years). Researchers recorded information on participants’ metabolic, behavioral and psychosocial risk factors; all participants had at least one follow-up visit. The primary outcome was a composite of major CV events, defined as CV death, MI, stroke and HF. Researchers reported the prevalence of each risk factor in women and men, HRs and population-attributable fractions associated with major CVD.
As of the data cutoff of Sept. 13, 2021, researchers observed 4,280 major CVD events in women (age-standardized incidence rate, 5 events per 1,000 person-years) and 4,911 in men (age-standardized incidence rate, 8.2 per 1,000 person-years).
Compared with men, women presented with a more favorable CV risk profile, especially at younger ages. HRs for metabolic risk factors were similar in women and men, except for non-HDL, for which high non-HDL was associated with an HR for major CVD of 1.11 in women (95% CI, 1.01-1.21) and 1.28 in men (95% CI, 1.19-1.39; P for interaction = .0037), with a consistent pattern for higher risk among men than women with other lipid markers.
Researchers also observed that maintaining a diet with a PURE score of 4 or lower (score range, 0-8) was more strongly associated with major CVD in women than in men, with HRs of 1.17 (95% CI, 1.08-1.26) and 1.07 (95% CI, 0.99-1.15; P for interaction = .0065), respectively.
In contrast, symptoms of depression were more strongly associated with CVD in men than in women, with the HRs for symptoms of depression being higher in men than in women (P for interaction = .0002). “The HRs of other behavioral and psychosocial risk factors, as well as grip strength and household air pollution, were similar among women and men,” the researchers wrote.
The total population-attributable fractions associated with behavioral and psychosocial risk factors were greater in men than in women (15.7% vs. 8.4%) mostly due to the larger contribution of smoking to population-attributable fractions in men (10.7%) vs. women (1.3%).
“Our results emphasize the importance of a similar strategy for the prevention of cardiovascular disease in both sexes,” the researchers wrote. “However, the increased risk of cardiovascular disease in men might be substantially attenuated with better reductions in tobacco use and lipid concentrations.”
FRIDAY, Sept. 23, 2022 (HealthDay News) — An increased risk of blood clots persists for close to a year after a COVID-19 infection, a large study shows.
The health records of 48 million unvaccinated adults in the United Kingdom suggest that the pandemic’s first wave in 2020 may have led to an additional 10,500 cases of heart attack, stroke and other blood clot complications such as deep vein thrombosis, in England and Wales alone.
The risk of blood clots continues for at least 49 weeks after infection, the study found.
“We have shown that even people who were not hospitalized faced a higher risk of blood clots in the first wave,” said study co-leader Angela Wood, associate director of the British Heart Foundation Data Science Centre.
“While the risk to individuals remains small, the effect on the public’s health could be substantial and strategies to prevent vascular events will be important as we continue through the pandemic,” Wood said in a news release from Health Data Research UK, which sponsors the center.
Researchers found that the risks did lessen over time.
Heart attacks and strokes are mainly caused by blood clots blocking arteries.
The risk of clots in veins was 33 times greater in the week after COVID diagnosis, dropping to eight times greater after four weeks. Conditions caused by these clots include deep vein thrombosis and pulmonary embolism, which can be fatal.
By 26 to 49 weeks after a COVID diagnosis, the risk dropped to 1.3 times more likely for clots in arteries and 1.8 times more likely for clots in veins, the study showed.
While people who were not hospitalized had a lower risk, it was not zero, the study found.
Overall, individual risk remains low, the authors said. Men over 80 years of age are at highest risk.
“We are reassured that the risk drops quite quickly — particularly for heart attacks and strokes — but the finding that it remains elevated for some time highlights the longer-term effects of COVID-19 that we are only beginning to understand,” said study co-leader Jonathan Sterne, director of the NIHR Bristol Biomedical Research Center and of Health Data Research UK South West.
The authors said steps such as giving high-risk patients blood pressure-lowering medication could help reduce cases of serious clots.
Researchers are now studying newer data to understand how vaccination and the impact of new COVID variants may affect blood clotting risks.
The findings were recently published in the journal Circulation.
The U.S. Centers for Disease Control and Prevention has more on blood clots.
SOURCE: Health Data Research UK, news release, Sept. 20, 2022
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