I’m a doctor and I joined The Doctors to talk food safety

I don’t ask anyone to call me doctor; I find it a bit awkward and pretentious.

I guess the title matters to some folks. So much so that it’s the basis for a nationally syndicated talk show produced by another doctor, Dr. Phil. Today, an episode I taped with the good doctors about a month ago aired.

We talked oysters, sprouts, raw milk and undercooked beef for a few minutes. I got my plug in for using a thermometer (although I think I erroneously said meat instead of beef).

I tried not to look too goofy (not sure I accomplished that).

My face isn’t always washed out but I ended up doing the interview via Skype from my home office (with an antique Hespeler hockey stick in the background), in direct afternoon sunlight, instead of my planned location of a campus office. The locale change was due to the 5” of snow that hit Raleigh the day before. I wasn’t driving anywhere with the NC snow-excited drivers.

I’m also not the creator of Barf Blog. I just happen to host the barfblog collective. And contribute to it sometimes.

Oh well, can’t get it all right, but food safety made it into a couple of million homes this afternoon.

But there’s no way the segment was as impactful as the one previous to mine – it was about farting at the gym.

Why we had don’t eat poop shirts in 4 languages: CDC Emergency partners and limited English proficiency

According to the U.S. Centers for Disease Control there are at least 350 languages spoken in U.S. homes (2009-2013 data).

People who have limited English proficiency can be found in all 50 states (2014 data).

About 65,00 people in the U.S. who have limited English proficiency speak Navajo or another native North American Language (2009-2013 data).

    Effective communication during an emergency can sometimes mean the difference between life and death. This is true whether communicating with those whose primary language is English or with people who have limited English proficiency. People who are limited English proficient (LEP) are those who “do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English” (https://www.lep.gov/faqs/faqs.html#OneQ1).

People who are LEP can be found throughout the United States and when it comes to planning for, responding to, and recovering from disasters, considering their needs can help ensure a better emergency response. Below are some tips from our colleagues at the U.S. Department of Justice (DOJ) for reaching LEP communities in emergency preparedness, response, and recovery.

Establish policies and procedures that include language access in your emergency plan.

Identify the language groups in your area.

Ensure LEP individuals can access your programs and services.

Conduct outreach efforts.

Include LEP individuals and language access issues in training,

Provide notifications, warnings, and other information in the languages of the affected communities.

Plan for language access needs as part of survivor care.

Do not rely upon children as interpreters and translators.

For more information on how to carry out these recommendations and where to find tools to help take action, see Tips and Tools for Reaching Limited English Proficient Communities in Emergency Preparedness, Response, and Recovery.

Hosts on a viral planet: When Herpes infects the eye

In the summer of 1985, I was working in a cool lab, and about to enter the final year of my undergraduate degree in molecular biology and genetics.

And I was living with a girl.

In Aug. 1985, we got tickets to go see Neil Young and the International Harvesters at the CNE (the Canadian National Exhibition, or the Ex) and I fell ridiculously ill.

I was in bed for two weeks, barfing, and in agony – a great way to start a new relationship that would bear four beautiful daughters.

I made it out of bed to see Neil and the Harvesters.

The next day I went home to Brantford, Ontario, Canada.

I was really, really sick, my eye really, really hurt, and my parents suggested I go see the eye doctor.

Within 5 minutes, he diagnosed eye Herpes, prescribed a retroviral cream, and I was quickly cured.

Yeah, science.

I have been exceedingly public about this story in the fantastical hope that others may be spared some of the pain, or at least have it contained.

Sarah Zhang of The Atlantic writes – 33 years later – that Herpes simplex virus type 1 is best known as the culprit behind cold sores. When it’s not causing itchy, crusty sores on the mouth, it hides in the bundle of nerves that run through the face. And it’s super common. An estimated 50 to 90 percent of people harbor lifelong infections of HSV-1—largely without incident.

But in some cases, HSV-1 can run through that bundles of nerves in the face and erupt in the eye. Or maybe it gets into the eye from the outside. No one is really sure. In any case, HSV-1 can definitely infect the eye. (In case you’re wondering: HSV-1 can also cause genital infections, though it’s herpes simplex virus type 2 that is more commonly associated with genital herpes.)

Herpes in the eye is as bad as it sounds. The virus infects the cornea, forming tree-like branching ulcers across the eye. It can cause irritation, pain, sensitivity to light, and ultimately blindness if untreated. Herpes in the eye is a leading cause of blindness in the world. The cornea, after all, is a transparent layer of tissue at the front of the eye, whose job is essentially to let in as much light as possible. Infection can turn the cornea cloudy—permanently.

In most cases, herpes infections in the eye can be treated with antiviral drugs like Zovirax, but the herpes viruses are becoming increasingly resistant to these drugs. Scarred corneas can also be replaced with a transplant, but past infection makes the eye more likely to reject the new tissue. Plus, once you get herpes in the eye, it can keep coming back—just like cold sores. “For some patients that experience this, there’s absolutely nothing we do,” says Dan Carr, an HSV-1 researcher at the University of Oklahoma. “Essentially they’re going to go blind if something else doesn’t happen”—if new treatments don’t become available.

Enter now a surprising new study about herpes. Deepak Shukla, a virologist at the University of Illinois at Chicago, and colleagues have identified a molecule called BX795 that clears HSV-1 infections in human cells and in mice—with few side effects, it seems.

It’s a surprise because Shukla’s team originally threw BX795 onto HSV-1-infected cells thinking it would make the viruses grow better in the lab. (They were trying to study the virus’s basic functions.) That’s because BX795 is known to inhibit a enzyme called TBK1 that turns on the human immune response. Dampen the immune response, and you should get more viruses, right?

“We saw the opposite,” says Shukla. BX795 appears to play another role in yet another human enzyme that viruses hijack to synthesize their own viral proteins. Shukla’s team tested BX795 in cultured human cells, human corneas, and mice with herpes eye infections. It worked to suppress the herpes virus in all those cases—and often at lower concentrations than existing antiviral drugs.

Most exciting of all, BX795 could represent an entirely new class of drugs for herpes. Existing drugs generally work by inhibiting the virus’s DNA (or RNA) replication, blocking it from making more copies of itself. Since the drugs work in such similar ways, it’s easy for the virus to evolve resistance to all of them. “A second class is almost nonexistent. That’s where I think our discovery is really important,” says Shukla. BX795, remember, prevents protein synthesis instead. Shukla is now testing it to see if BX795 offers broad protection against other related viruses like those causing chicken pox and mono.

I spent the weekends of 1979 bagging rock, and while I thought I was just really bored, I had mono.

 

Woman’s rare eye infection highlights (low) risk of parasite spread by flies

Susan Perry of the Minnesota Post reports an Oregon woman is the first known person to become infected with a tiny parasitic worm that lives in the eyes of cattle, according to a case study report published Monday by researchers at the Centers for Disease Control and Prevention (CDC).

Although common in animals, eye-worm infections in humans are extremely rare. And, if caught and treated early, they don’t cause any permanent damage to the eye.

“This is only the 11th time a person has been infected by eye worms in North America,” lead author Richard Bradbury, who heads the CDC’s Parasite Diagnostics and Biology Laboratory, told CNN. “But what was really exciting it that it is a new species that has never infected people before. It’s a cattle worm that somehow jumped into a human.”

The woman, 28-year-old Abby Beckley, was working on a salmon boat in Alaska two summers ago when her left eye became irritated and inflamed. A week later, when the symptoms didn’t go away, she decided to investigate.

BuzzFeed reporter Nidhi Subbaraman, who interviewed Beckley, describes what happened next:

Standing at the mirror in the galley, [Beckley] plucked at her eyeball, as if extracting a contact lens. 

“I put my fingers in there in kind of a picking motion and I pulled out a worm,” Beckley [said]. “I looked at my finger and it was moving and I was shocked.” 

Beckley said she woke up her bunkmate to show her the worm, a piece of tangled white fluff wriggling at the end of her index finger. “She confirmed I wasn’t crazy,” Beckley said.

Over the course of the next few days she pulled out about a half dozen more worms. “I was living with these things, and I’d just keep pulling them out when I’d feel them,” Beckley said. 

Beckley flew home and went to see specialists at the Oregon Science and Health Laboratory in Portland. They extracted two more worms, and sent one to the CDC for analysis. It was identified as being the nematode Thelazia gulosa, which commonly infects the eyes of cattle, but had never been found in humans.

The case report was published online in the American Journal of Tropical Medicine and Hygiene, where it can be read in full.

New food safety tools and messages deserve investigation

Nine years ago I had my most memorable bout with foodborne illness. I had Campylobacter and it was terrible. It all started with a trip to visit Doug in Kansas.
I gave a somewhat incoherent talk to an undergraduate food microbiology class while sweating; slept most of my visit away; went to a football game; left the football game at halftime; spent two nights rushing to the bathroom every hour to evacuate my intestines.
I wanted to blame Doug.
He brings out the best in people.
After a feverish trip home (diarrhea on a plane sucks) and crashing for the remainder of the weekend I went to my doctor to get things checked out. I described my symptoms, had a rectal exam (fun) and was given the materials needed for a stool sample. 
The idea of stool sample harvesting was way more fun than the actual act.
It’s amazing any foodborne illnesses are confirmed with stool samples because the process is a bit nuts. It took some thinking to figure out how to catch the sample without contaminating it with water or urine. The final decision was to use the bucket from our cleaned and sanitized salad spinner – which has since been retired – and place it in the toilet bowl.
I took the poop harvest and filled three vials to fill (one for C. difficile, one for parasites and another for other pathogens), and a bonus margarine-like tub for “other things.” The vials were easy, they came with their own spoons. After ten swipes across the base of the former salad spinner I was able to messily get the rest of the sample collected in the tub. Then came the clean-up.  This whole episode took me about 45 minutes.
I proudly returned to the doctor’s office with samples in hand. I asked her what percentage of stool sample kits come back filled with poop. She said about 10%.
That’s the problem with clinical confirmation of foodborne illness pathogens.
Patrick Quade and the iwaspoisoned.com group is trying to add to the toolbox of public health foodborne illness investigations, because not a lot of samples make it to public health so cases can be confirmed.
According to the New York Times, this is the era of internet-assisted consumer revenge, and as scorned customers in industries from dentistry to dog-walking have used digital platforms to broadcast their displeasure, the balance of power has tipped considerably in the buyer’s favor. This is especially true of IWasPoisoned, which has collected about 89,000 reports since it opened in 2009. 
Consumers use the site to decide which restaurants to avoid, and public health departments and food industry groups routinely monitor its submissions, hoping to identify outbreaks before they spread. The site has even begun to tilt stocks, as traders on Wall Street see the value of knowing which national restaurant chain might soon have a food-safety crisis on its hands.
Not everyone is happy about the added transparency. Restaurant executives have criticized IWasPoisoned for allowing anonymous and unverified submissions, which they say leads to false reports and irresponsible fear-mongering. Some public health officials have objected on the grounds that food poisoning victims can’t be trusted to correctly identify what made them sick.
“It’s not helping food safety,” said Martin Wiedmann, a professor of food safety at Cornell University. “If you want to trace food-borne illness, it needs to be done by public health departments, and it needs to include food history.”
I dunno. Maybe it will help as a supplemental data set. There are folks in local and state health departments subscribing to alerts that can lead to earlier and more focused investigations.
The end of my story is that I was diagnosed with campylobacteriosis. I became a statistic. I was administered a food history questionnaire. No answers on a source ever came back. New tools to crowdsource public health information can act as a an early warning system for outbreak and illness investigators.

It’s a thing (in theatres Friday): Poop Talk

We were ahead of the curve on mass blogging about barf, we had Don’t Eat Poop T-shirts in four languages (Bill Murray got the Chinese one), but never had the resources to pull off a movie.

Carly Mallenbaum of USA Today asks, should humans be uncomfortable talking about something that everyone does, regardless of age, race, religion, income or gender?.

At least that’s what director Aaron Feldman hopes you do while watching his documentary, Poop Talk (in select theaters Friday in New York, Los Angeles, Chicago, Atlanta and other cities, and on demand), which opens a dialogue about doo-doo with the help of dozens of scientists and comedians.

Guests include Dr. Drew Pinsky (who explains that being grossed out by feces has evolutionary purposes), a skittish Eric Stonestreet (the Modern Family actor says he can’t poop in a public restroom), a candid Nicole Byer (she talks about using a plane toilet while eating a burger), a wise Rob Corddry (he owns a tricked-out bidet) and the affable Kumail Nanjiani.

Yes, that’s the same Nanjiani who recently earned an Oscar nomination for best original screenplay for his personal love story, The Big Sick.

The critically acclaimed comedy contains it’s own poop scene, as Kumail tries to figure out why his girlfriend, Emily (played by Zoe Kazan), wants to go to a diner at 3 a.m. for, she says, “a cup of coffee.”

 “Why are you being so weird?” Kumail asks a shifty Emily, who finally reveals her hidden motive: “I have to take a huge (freaking) dookie!”

In Poop Talk, Nanjiani says there are plenty more scatological stories where that one came from.

There’s the joke his dad used to tell about how swallowing gum would make your poop become “a yo-yo.” Nanjiani hated that line, especially because as a child he avoided pooping at all costs.

“I figured (that poop is) all the stuff your body doesn’t need. So if I could figure out the formula and just eat what my body needs, it would all get absorbed into me and then I would never have to poop, right?” he says.

The comedian also recalls a time when he was eight years old. He was talking to another kid at a party, “and I noticed he had (pooped) himself,” Nanjiani says. “He looked me dead in the eyes and said, ‘That’s not poo; it’s party cream.’ “

Hosts on a viral planet: Ancient virus could be the reason humans can think

An ancient virus could be responsible for human consciousness, giving you the ability to think for yourself.

Researchers in the Dept. of Neurobiology at the University of Massachusetts Medical School have linked a human gene responsible for conscious thought to a virus that was spread in the early days of humanity.

Two papers published in the journal Cell discuss the origins of the Arc gene, which packages up genetic information and sends it around nerve cells in little virus-style capsules.

Sean Keach of the New York Post writes these packages of information are believed to be critical to how our nerves communicate and could be responsible for our thoughts.

Elissa D. Pastuzyn, who authored one of the studies, said: “Evolutionary analysis indicates that Arc is derived from a vertebrate lineage of Ty3/gypsy retrotransposons, which are also ancestors to retroviruses.”

It’s believed that between 40 percent and 80 percent of the human genome was developed thanks to ancient viruses.

Viruses make active changes to your cells, injecting their own genetic code.

This can often be entirely useless — and sometimes causes harm, including the reproduction of more viruses — but occasionally we end up with useful modifications.

And it seems an ancient virus may have given rise to all human thought — thanks to the Arc gene.

Pastuzyn said that the virus was “repurposed during evolution, to mediate intercellular communication in the nervous system.”

James Ashley, who authored one of the studies, said: “The neuronal gene Arc is essential for long-lasting information storage in the mammalian brain, mediates various forms of synaptic plasticity and has been implicated in neurodevelopmental disorders.”

He added that mutations in the gene have been “linked to autism and schizophrenia,” which suggests that Arc has a pivotal role to play in how we perceive and react to the world around us.

Retrovirus-like Gag Protein Arc1 Binds RNA and Traffics across Synaptic Boutons

 Cell Volume 172, Issues 1-2, p262–274.e11

Arc/Arg3.1 is required for synaptic plasticity and cognition, and mutations in this gene are linked to autism and schizophrenia. Arc bears a domain resembling retroviral/retrotransposon Gag-like proteins, which multimerize into a capsid that packages viral RNA. The significance of such a domain in a plasticity molecule is uncertain. Here, we report that the Drosophila Arc1 protein forms capsid-like structures that bind darc1 mRNA in neurons and is loaded into extracellular vesicles that are transferred from motorneurons to muscles. This loading and transfer depends on the darc1-mRNA 3′ untranslated region, which contains retrotransposon-like sequences. Disrupting transfer blocks synaptic plasticity, suggesting that transfer of dArc1 complexed with its mRNA is required for this function. Notably, cultured cells also release extracellular vesicles containing the Gag region of the Copia retrotransposon complexed with its own mRNA. Taken together, our results point to a trans-synaptic mRNA transport mechanism involving retrovirus-like capsids and extracellular vesicles.

Australian student who sold monkey skull to ‘people from Pirates of the Caribbean’ fined

A few years ago, one of those Johnny-Depp-pirate movies — it may have been 5 — was filming down the highway at the Gold Coast.

The set was plagued by drama when it was discovered Depp and then wife Amber Heard had illegally brought two dogs into the country.

This prompted deputy premier Banaby-the-bloody-carp Joyce (right, not exactly as shown) to question Depp’s acting ability after the couple apologized, which shows how small Australia is because now Joyce is embroiled in his own scandalous activities, involving humans, not pets.

Behind the sideshow of movie making, divorce and apologies, a Canberra university student was on Thursday fined for illegally possessing and importing exotic animal remains into Australia, in a case that has shed some light on the shadowy world of wildlife trade.

Alexandra Back of the Canberra Times reports that for years, avid collector Brent Philip Counsell, 28, dealt in what a magistrate described as a “macabre” trade of skulls and animal specimens, once selling a primate skull to the people making the Pirates of the Caribbean movie in Brisbane.

In 2016 authorities from the department of environment raided Counsell’s home in Deakin where they found and seized about 100 animal specimens from the living room and bedroom.

Australian environment law makes it illegal to either possess or import protected exotic animal specimens without a permit.

Over several years, Counsell either illegally imported or possessed a small primate skull threaded on a necklace, the skulls of a brown bear and a gibbon, a taxidermy buzzard, water monitor lizard, and teeth from a bear and a hippopotamus tooth.

When he spoke to investigators, Counsell admitted possessing and selling species from his website wulfe.com.au, which he had since shut down.

One of the charges stemmed from an admission Counsell made to authorities after they had searched his home, that he had sold a primate skull to the “people” behind the Pirates of the Caribbean movie that was filming in Brisbane.

He tried to avoid detection, and prosecutors found on his phone articles that offered tips about how to send skulls overseas without being noticed by customs.

Rabies (maybe) from bats living in a sorority house, Indiana, 2017

In February 2017, the Indiana State Department of Health (ISDH) was notified of bat exposures at a university sorority house. The initial complaint was made to ISDH because of concerns for food sanitation. Bats had been routinely sighted in shared living areas and hallways. ISDH, in consultation with the U.S. Centers for Disease Control, collaborated with the university and sorority to assess residents and staff members for potential rabies risk. In 2016, 4.3% of all bats tested in Indiana were positive for rabies. The longest incubation period recorded for indigenously acquired bat rabies is 270 days (1); therefore, out of an abundance of caution, ISDH conducted interviews with 140 students and eight employees who resided or worked in the sorority house during the preceding 12 months, all of whom were considered to have possibly been exposed. A web-based survey was administered in February to collect information about bat exposures, which was used to categorize all respondents into having a low, medium, or high risk for rabies exposure per CDC guidance (2).

Persons who reported a bite, scratch, or direct skin contact with a bat were categorized as having a high risk. Persons were categorized as having moderate risk if they reported waking and finding a bat in the same room where they were sleeping. Persons who reported no bat exposure were categorized as having a low risk. Respondents categorized as having a high or moderate risk had follow-up interviews in person or by telephone.

Among the 148 possibly exposed persons, 100 (68%) responded to the questionnaire, including 92 (66%) students and all eight employees; 94 respondents reported ever having seen a bat in the sorority house. Among those 94 persons, 70 (74%) reported having seen a bat within the previous 12 months, and 34 (36%) reported seeing a bat ≤1 month ago. Among respondents who reported ever having seen a bat in the sorority house, 13 (14%) were identified as having a moderate or high risk for rabies exposure, including 11 sorority members, one university employee, and one nonsorority member student. After follow-up interviews, nine of these 13 persons were reclassified as having a low risk for rabies exposure. The remaining four persons were considered to have a high (three persons) or a moderate (one) risk. All four persons received a recommendation for postexposure prophylaxis (PEP), which consists of human rabies immune globulin and a series of 4 doses of rabies vaccine. Two persons completed the PEP series during March 20–April 18, and two declined PEP because of a perceived lack of risk. No respondent had developed clinical rabies as of February 2018.

ISDH learned that bats had been roosting in the building for approximately 30 years. Commercial wildlife operators conducted an environmental investigation in March and identified multiple small openings between the house’s exterior wall and doorframe, which can serve as points of ingress or egress for bats. In addition, certain students reported hearing scratching behind a wall inside the house’s common space. This wall was scheduled to be removed as part of a house remodel during summer 2017. A commercial wildlife control operator repaired the openings and completed building remediation during this time. Students returned to the house in August 2017. No bat sightings have been reported since students returned.

This is the first reported instance of a mass bat exposure in a fraternity or sorority house. Multiple high-risk rabies exposures occurred in this sorority house, attributable to bat colonization of the building. The initial complaint to ISDH related to concerns for food sanitation, rather than rabies, is consistent with previous reports indicating an underappreciation of the health risks associated with indoor bat exposures (3). ISDH communicated the risk for rabies exposure at meetings with students and university housing directors. All bat exposure events should be reported immediately to public health officials, who can provide advice about rabies risk assessments and determination of the need for PEP.

Notes from the Field: Assessment of Rabies Exposure Risk Among Residents of a University Sorority House — Indiana, February 2017

Morbidity and Mortality Weekly Report; February 9, 2018; 67(5);166

Betsy Schroeder, DVM; Alex Boland, MPH; Emily G. Pieracci, DVM; Jesse D. Blanton, PhD; Brett Peterson, MD; Jennifer Brown, DVM

https://www.cdc.gov/mmwr/volumes/67/wr/mm6705a4.htm?s_cid=mm6705a4_e

Corresponding author: Betsy Schroeder, BSchroeder@cdc.gov, 814-248-5774.

1Epidemic Intelligence Service, CDC; 2Indiana State Department of Health; 3Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

References

De Serres G, Dallaire F, Côte M, Skowronski DM. Bat rabies in the United States and Canada from 1950 through 2007: human cases with and without bat contact. Clin Infect Dis 2008;46:1329–37. CrossRef PubMed

CDC. Assessment of risk for exposure to bats in sleeping quarters before and during remediation—Kentucky, 2012. MMWR Morb Mortal Wkly Rep 2013;62:382–4. PubMed

DeMent J, Trevino-Garrison I. Investigation of potential rabies exposure while attending a camp, Barton County, June 2010. Topeka, KS: Kansas Department of Health and Environment; 2010. http://www.kdheks.gov/epi/download/Bats_at_Camp_Final_Report.pdf

Can the Internet help make a better person?

I don’t like myself.

Never have.

I’ve been going to shrinks now for a few years, and while I like the group activity – like the original Bob Newhart show – it’s not really going anywhere, so I thought I’d enlist the help of the collective barfblog.com brain.

I really love Amy, but my level of self-loathing is affecting our relationship.

Any tips and tidbits, please pass along, if it works we can write a book.