The News and Record reported 14 February 2010 that red imported fire ants have reached the threshold of placing Guilford County on the list of areas under agricultural quarantine.  Although fire ant infestations will clearly impact businesses there are medical problems that should be understood as well.

Fire ants differ from local ants in their tendency to swarm and to bite ferociously.  The bite of a fire ant injects venom into the skin.  The venom contains two substances: 1. Alkaloids and 2. Proteins similar to yellow jacket venom.

The local reactions can be either an immediate (within 20 minutes) hive-like reaction (called a “wheal and flare”), a sterile pustule or a large red reaction around the bite.  These last two reactions are due to the alkaloids.

However, the yellow jacket like proteins can cause anaphylactic reactions (swelling of the respiratory passages and vascular collapse).

In bad weather (cold, flooding or drought) fire ants can move inside.  Because of their aggressiveness and the tendency to swarm, massive attacks can occur where debilitated adults or very young children are unable to flee and receive thousands of bites.  Massive attacks occur indoor: in nursing homes or hospitals.

Control of fire ant infestations include application of indoor and outdoor pesticides and biological agents.  The options of agents to use are numerous and complex.  As the consequences to human health are significant, professional pest control companies should be hired.

As there are treatments available for significant fire ant bites, it is worth seeking medical attention for most bites.

Additional information can be found at the CDC website (about half way down the page), from OSHA, and from Texas A&M University.  In addition, there is a great resource for medical information, UpToDate.com.  At UpToDate.com type in any medical topic, in this case “fire ants”, in the search box.

As I mentioned in the post earlier this week, the CDC has published details on the ongoing epidemic of mumps occurring in Brooklyn, New York.  Although I anticipated that the community involved might have a low vaccination rate, it’s actually quite good with childhood vaccinations in the 90% range.  So the mumps portion of the measles, mumps, rubella vaccine seems to be less than optimal in providing long standing protective immunity.  The lessons drawn from the New York epidemic may well change how we recommend vaccine schedules in the future.  For the moment, we need to pay attention to further communications from our state and federal experts.

H1N1 Immunization Campaign Targets College Students

RALEIGH — In response to continued cases of H1N1 on college campuses across the state, the N.C. Division of Public Health is sponsoring a college immunization campaign during the month of February to protect young people against the flu. “While flu cases are not at the level they were back in the fall, we are seeing clear evidence that H1N1 is still striking young people,” said Zack Moore, M.D., public health epidemiologist.

From late January through early February, student health centers outpaced other providers in cases of influenza-like illness. A similar trend was evident during the fall wave of H1N1, with student health centers consistently seeing higher-than-average rates of flu. However, statistics from the state’s Immunization Branch show college-age individuals remain the least immunized overall in the state. As of Jan. 30, only 5 percent of 19- to 24-year-olds had received vaccine distributed to colleges through the N.C. Division of Public Health.

“Students appear to be less interested now because H1N1 is not getting the publicity it did in the fall,” said Katrin Wesner, director of Abrons Student Health Center at the University of North Carolina at Wilmington. “This campaign will help us re-energize our efforts and remind people that it is not too late to be vaccinated.”

College mascots are joining the campaign to encourage students to get immunized. Mascots from eight colleges and universities will be sporting bandages with the message “The Flu Stops With Me” at selected basketball games during February. In addition to their campus efforts, student health services personnel will offer immunization clinics at games to reach students and others who have not yet been vaccinated.

“This is a great opportunity for us to reach one of our most at-risk populations,” said State Health Director Jeffrey Engel, M.D. “We appreciate the support of our colleges and universities in helping us get the message out about the importance of immunization.”

Colleges involved in the campaign include N.C. State University, Fayetteville State University, UNC-Chapel Hill, UNC-Charlotte, North Carolina A&T, UNC-Wilmington, East Carolina University and Winston-Salem State University.

For information about H1N1 and immunization clinics, see flu.nc.gov. Students may also check with the student health center at their college or university.

I received a concerning email from Sue Cameron of the US Fish and Wildlife Service alerting public health to a fungal infection in bats.  The fungus called “Geomyces destructans” thrives in cold and humid places (caves) where bats live. The fungus has spread by means yet to be determined from the northeast to Virginia. It is anticipated that it will enter western North Carolina within the year. The bat colonies exhibiting this fungal infection (it appears as white mold on the snouts of the bats) are dying rapidly.
Given that we live in a world where we are all interconnected, the devastation of the bat populations will have consequences to humans. The immediate foreseeable problem will be an increase in mosquitoes, as bats feed on insects. With more mosquitoes, there will be more mosquito-borne infections such as West Nile or Encephalitis viruses.
The U.S. Fish & Wildlife Service maintains a WNS website that includes the latest WNS news, information on cave closings, decontamination protocols, and information on what you can do to help.

I’m certain that the CDC will report the details of the epidemic of mumps currently ongoing in New York within the next several weeks.  Suffice it to say that there is price to pay when a community forgoes vaccinations for childhood diseases,such as measles, mumps and rubella.  In our global world and international travel, diseases that are rare in present society can be introduced in one plane flight.  If the disease finds a susceptible community, then it will spread unabated.

As an Infectious Diseases consultant for two and a half decades I prescribed antibiotics to people with life threatening infections.

I acknowledged that each time I gave an antibiotic there was a risk that rather than make someone better, that the antibiotic might cause a side effect. I made a habit of informing patients and family members that the antibiotic could cause an allergic reaction, or an upset stomach, or diarrhea, or a rash, or difficulty sleeping, or make them fat. Some side effects might mean they needed to stop the drugs. Other side effects would go away with time even if you continued the drug.

If bad side effects occurred then there would usually be alternatives to prescribe. But at that moment in time, it seemed better for them to take the antibiotic rather than to allow the infection to continue.

Some antibiotics are so toxic that I wouldn’t start them until I was close
to absolute certainty that they had the disease the antibiotics were designed to treat. Once I was convinced…by biopsy or culture…that the disease was present I would hold my breath and give the antibiotics…while maintaining vigilance for problems.

I’m recounting these experiences to tell you it is NORMAL and EXPECTED for doctors to tell people of potential problems with medicines. Side effects happen. Side effects can be measured and quantified. But with experience, doctors come to know what side effects will happen with each antibiotic or drug.

We know penicillins can cause a rash. They don’t affect sleep.

Sustiva (an HIV treatment) can cause a rash AND can cause wicked dreams.

So if vaccines caused autism, why would I not tell people? I don’t have stock in vaccine companies. I don’t get paid to give vaccines that aren’t safe. It’s always easier to tell the truth…you don’t have to remember what you said each time because the next time you’ll say the same thing.

It comes as no surprise therefore to read yesterday that the centerpiece in the “vaccine causes autism” argument has been retracted both on scientific and ethical grounds. If a scientist is so convinced in the outcome of the study that they are willing to stack the deck and experiment on children without ethical review panel permission, then one should question their conclusions. Twelve years after the event, the editors of the journal are playing the disappointed parent and saying to their miscreant son, “You are dead to me”.

Of course that plays well in the mafia movies, rarely happens in scientific literature, and doesn’t really help the arguments too much. They are twelve years after the publication…twelve years of misdirection to many.

The medical and scientific communities have found no evidence that autism is due to vaccines. There is mounting evidence that autism has a genetic base.

So by blaming the wrong culprit and avoiding vaccinations, one risks allowing children to get sick with a vaccine preventable illness. AND we waste time going down a wrong path, when focusing on the actual cause of autism is overlooked.