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This x-ray of the hands of someone with leprosy was taken in Thailand. The disease causes deformities and contractures, seen here. Two schoolchildren in California are suspected of having leprosy, but where might they have caught the disease? This week, officials in Riverside Country (which is near Los Angeles) said they are investigating the suspected cases of leprosy, now usually called Hansen's disease, at an elementary school in the area. Nursing staff at the school first notified officials about the possible infections on Sept. 2, but it will take several weeks to confirm them, according to the Los Angeles Times. Cases of Hansen's disease in the United States are rare, but they do occur, with about 100 to 200 cases typically reported each year, according to the Centers for Disease Control and Prevention. In 2014, there were 175 new cases of Hansen's disease diagnosed in the United States, and nearly three-quarters of these cases were reported in seven states: Arkansas, California, Florida, Hawaii, Louisiana, New York and Texas, according to the U.S. National Hansen's Disease (Leprosy) Program. "There's a lot of stigma and a lot of misunderstanding about leprosy," said Dr. Amesh Adalja, an infectious-disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security. "In the United States, there are thousands of people" who have the disease, Adalja told Live Science. It's estimated that, overall, about 6,500 people in the United States have Hansen's disease, and about half of these require active medical treatment, according to the National Hansen's Disease Program. [Top 10 Stigmatized Health Disorders] There's currently not enough information provided about these two suspected case to know where they might have originated, Adalja said. But armadillos in the United States are known to harbor the bacteria that cause the disease, and it's possible for people to become infected through contact with the animals, Adalja said, although the risk of this is low. People can also become infected with leprosy through prolonged close contact with patients who have leprosy, Adalja said. Because the disease is not very contagious, people are unlikely to become infected through casual contact, he added. In addition, a sizable number of the people who have Hansen's disease in the United States (about 60 percent) were born in another country, Adalja said, and so it's possible they contracted the disease in another country, but this is not certain. Countries with more widespread leprosy transmission include Angola, Brazil, Central African Republic, Democratic Republic of Congo, Federated States of Micronesia, India, Kiribati, Madagascar, Mozambique, Nepal, Republic of Marshall Islands and the United Republic of Tanzania, according to the CDC. The disease is caused by a bacterium known as Mycobacterium leprae. It mainly affects the skin, peripheral nerves, upper respiratory tract, eyes and lining of the nose, according to the National Institutes of Health. The bacteria multiply very slowly, so it may take two to 10 years before a person who is infected with the bacteria has any symptoms, the CDC says. Left untreated, the bacteria can cause permanent damage to the skin, nerves, limbs and eyes (including paralysis and blindness), according to the World Health Organization. But the disease is easily treatable with antibiotics, according to the CDC.  And patients are unable to transmit the disease to other people after taking just a few doses of antibiotics. Hansen's disease is not easily spread between people, and it's unlikely that people would catch the disease in a school or work environment, Barbara Cole, of the Riverside County Department of Public Health, told the Los Angeles Times. One reason that the disease doesn't appear to be very contagious is that most people are naturally immune to the disease — it's estimated that about 95 percent of people are not able to contract leprosy, Adalja said. The school with the suspected cases said it has disinfected a few classrooms as a response to the news, according to the Los Angeles Times. But Adalja said that this action was probably overdoing it relative to the risk that the cases pose. "Almost all of it will be overkill because this disease is not that contagious," Adalja said. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Newer isn't always better — some researchers are proposing to bring back an older version of the whooping cough vaccine, because multiple studies show that today's version doesn't protect as well as the earlier kind. In a new study, researchers suggest vaccinating children with one dose of the older whooping cough vaccine — called the whole-cell pertussis vaccine — and then giving them four doses of the current whooping cough vaccine in early childhood. (Whooping cough is also known as pertussis.) Currently, children are given five doses of the new vaccine. Using a mathematical model, the researchers found that this "combined" vaccination strategy could reduce the rate of whooping cough infections by up to 95 percent, and save millions of dollars in health care costs. Researchers from The Santa Fe Institute, a nonprofit research center in New Mexico, conducted the study. The older, whole-cell pertussis vaccine is linked with a higher rate of side effects, such as fever, than is the newer version. But because improved vaccines against whooping cough are likely years away, "in the interim, switching to the combined strategy is an effective option for reducing the disease and mortality" from whooping cough  the researchers wrote in their findings, published today (March 28) in the journal JAMA Pediatrics. [5 Dangerous Vaccine Myths] But even though the new study found that the benefits the combined strategy would outweigh the risks, questions remain about whether parents would accept a higher rate of side effects, especially among those parents who are already hesitant to vaccinate their children, experts said. The whole-cell pertussis vaccine was used in the United States from the 1940s until the 1990s, when doctors switched to a new version called the acellular pertussis vaccine, which was linked to fewer side effects. But studies soon found that, unlike the older version, the acellular pertussis vaccine did not produce long-lasting immunity against pertussis; the protection offered by the acellular vaccine wanes after a few years. Researchers have attributed the rise in whooping cough cases in recent years in part to the inferior protection offered by the acellular vaccine. In 2012, there were more than 48,200 cases of whooping cough in the United States, the most in any year since 1955. The current vaccine schedule calls for five doses of the acellular vaccine, with one dose occurring at each of the following times: ages 2 to 4 months, 4 to 6 months, 6 to 8 months, 18 to 24 months, and 4 to 5 years. In the new study, researchers compared using that schedule with a "combined" vaccine strategy, of giving an initial dose of the whole-cell pertussis vaccine followed by four doses of the acellular pertussis vaccine. The combined strategy would reduce symptomatic whooping cough cases by 95 percent, and would reduce cases in infants by 96 percent, compared with the current strategy, the models predicted. With the combined strategy, there would also be a 96 percent decrease in hospitalizations from whooping cough and a 95 percent decrease in infant deaths from the disease, compared with the acellular strategy. However, the combined strategy would have higher rates of vaccine side effects: There would be about 10 more cases of fever for every 100,000 vaccinations, and seven more cases of seizures for every 10 million vaccinations, compared with the acellular vaccine strategy. Overall, the combined strategy would lead to a 96 percent decrease in hospitalizations due to either whooping cough or vaccine-related side effects, the study found. Based on the new study, it seems the combined strategy would lead to better outcomes overall, said Dr. Amesh Adalja, an infectious-disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security. "When you look at the way they've modeled this, it seems to be, on balance, a better strategy than what we're doing currently," Adalja said. And giving just one dose of the whole-cell vaccine "maybe somewhat more palatable to people" than giving children five doses of this vaccine, Adalja said. The findings also support the idea that "the strategy we're using currently against pertussis is not the optimal model, and children are needlessly contracting pertussis because we're using an inferior vaccination strategy," Adalja said. Still, some experts were skeptical that parents would accept bringing back the whole-cell pertussis vaccine. "The problem is that you cannot model public perception," Dr. Mark Sawyer, a pediatric infectious disease specialist at the University of California, San Diego School of Medicine, wrote in an editorial accompanying the study in the journal. "Many in the vaccine-policy world cringe at the idea of re-introducing whole-cell pertussis vaccine." Sawyer noted that parents today are intolerant of any adverse side effects related to vaccines, even if such effects are rare. In the past, the public reaction to these side effects played a role in the rise of the anti-vaccine movement, Sawyer said. "Although bringing back whole-cell pertussis vaccine for a priming dose … makes sense from an immunologic perspective, other considerations will make this challenging," Sawyer said. Because the study used a mathematical model and was not conducted in the real world, more studies will need to validate the findings before policy would be changed, Adalja said. 5 Viruses That Are Scarier Than Ebola Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

The Ebola outbreak in West Africa is not over — just one day after the region was declared "Ebola-free," a new case of the virus was confirmed in Sierra Leone. The new case involved a 22-year-old woman, who was found dead in northern Sierra Leone and tested positive for the disease today (Jan. 15), according to The New York Times. Just yesterday, the World Health Organization declared the end of the Ebola outbreak in West Africa, because the three hardest-hit countries in the region — Guinea, Liberia and Sierra Leone — had not reported a new Ebola case for at least 42 days. (Health officials typically wait 42 days to declare a country Ebola-free because this is twice as long as the 21-day incubation period of the virus, or the time it takes for a person with the virus to start showing symptoms.) However, the new case in Sierra Leone is not unexpected — in its statement yesterday, the WHO stressed that all three West African countries were at high risk for additional, small outbreaks of the disease. "Even though being declared Ebola-free is a major milestone," there's no guarantee that there won't be additional flare-ups of the disease, said Dr. Amesh Adalja, an infectious-disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security. [10 Deadly Diseases That Hopped Across Species] WHO and its partners are now investigating how the woman in Sierra Leone became infected with Ebola, as well as identifying people who came into contact with the woman and taking steps to prevent further transmission. It's possible that the woman may have become infected by an Ebola survivor. In rare cases, the virus can be transmitted from survivors through sexual activity, because the virus can persist in the semen of male survivors for as long as a year, according to the WHO. The woman might also have been exposed to a person who had a mild case of Ebola that wasn't known by authorities, Adalja said. In addition, there have been reports of Ebola survivors becoming contagious again, even after they were cured of the disease. It's suspected that a female Ebola survivor in Liberia became contagious again after she became pregnant, and passed the disease to her son, Reuters reported last month. To help determine the source of the most recent Ebola case in Sierra Leone, health officials will need to trace the patient's activities in the days before she became ill, Adalja said. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

The most obvious symptom of microcephaly is that the child has a smaller head than others of the same age and gender. More Pregnant women who become infected with Zika virus may be at risk for not only having a child with microcephaly, but also having a fetus with other serious health issues, including problems with the nervous system and even fetal death, according to a new study from Brazil. The study — which provides some of the strongest evidence that Zika virus causes microcephaly — found that nearly one-third of women who had Zika infections during their pregnancy had an ultrasound that showed fetal abnormalities. These abnormalities included problems with growth, such as microcephaly (meaning an abnormally small head), problems with the placenta and lesions in the brain or spine. "Zika definitely causes the problems. We think microcephaly is only the tip of the iceberg," said study co-author Dr. Karin Nielsen-Saines, a professor of clinical pediatrics at the David Geffen School of Medicine at UCLA. [Zika Virus FAQs: Top Questions Answered] Infants and fetuses in the study showed a variety of problems, including calcification (or hardening) of brain tissues, problems with the amniotic fluid and an abnormally small body size. There were two stillbirths in the study. Usually, viral infections don't cause only one problem, and because of the array of problems now linked with Zika, the researchers suggest using the term congenitial Zika virus syndrome, Nielsen-Saines said. The new study provided a stronger type of evidence than previous studies of the effects of Zika during pregnancy because it was prospective, meaning that women who came into the clinic in Brazil were tested for Zika and then followed over time (regardless of whether or not they tested positive for the virus). In addition, the researchers tested the women for Zika by looking for the virus's genetic material – which is more reliable than looking for antibodies, or proteins produced by the immune system in response to a Zika infection, Nielsen-Saines said. The new study is "what people have been waiting for," in terms the type of evidence needed to prove that Zika infection in pregnancy causes microcephaly, said Dr. Amesh Adalja, an infectious disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security, who was not involved in the study. That's because the researchers compared pregnant women infected with the Zika virus with pregnant women who were not infected with Zika virus and lived in the same area — a so-called "case control" study. "This is the closest we've gotten to [proving] causation," Adalja said. Although more studies are still needed to solidify the link, "for all intents and purposes, this justifies the concern raised early on," that at least a proportion of the microcephaly cases in Brazil were caused by Zika virus, Adalja said. The Zika virus is currently spreading rapidly in Central and South America. Health officials became concerned about a link between the virus and microcephaly after there was a dramatic rise in cases of this birth defect in Brazil last year. The study involved 88 pregnant women in Rio de Janerio who were tested for Zika virus because they had recently developed a rash — one of the symptoms of the infection. Of these women, 72 tested positive for Zika virus, and they were at various stages of pregnancy – anywhere from 5 to 38 weeks pregnant. The researchers performed ultrasounds on 42 women who had a Zika infection and 16 women who did not have a Zika infection. (A number of women in the study who tested positive for Zika did not agree to have ultrasounds, Nielsen-Saines said, and in some of those cases, were due to women not wanting to know whether the fetuses they were carrying potentially had health problems.) About 30 percent of the Zika-infected women showed a fetal abnormality on their ultrasound, compared to none of the women without a Zika infection. The Zika-infected women were all previously healthy and did not have other risk factors for adverse pregnancy outcomes, the researchers said. [Zika Virus News: Complete Coverage Of The Outbreak] Five of the Zika-infected women (12 percent) had fetuses with microcephaly, but in most of these cases, the fetus also had a condition called intrauterine growth restriction, meaning the whole fetus was abnormally small, and not just the head. Seven women (16 percent) had fetuses with lesions on the brain or spinal cord, or other central nervous system problems, and 7 women appeared to have placental insufficiency, when the placenta doesn't work as it should so that the fetus does not receive a sufficient amount of oxygen and other nutrients. Two women infected with Zika had stillbirths at 36 and 38 weeks of pregnancy, respectively. In previous studies, there was some speculation that Zika infections may be more damaging if they strike earlier in pregnancy. But in the new findings, the stillbirths both happened in women who were infected late in their pregnancies, Nielsen-Saines said. And in another case, a baby had to be "urgently delivered" from a woman with a later Zika infection, because the baby would have died otherwise, she said. None of those three cases involved microcephaly or other problems with the central nervous system, but rather, these cases had other problems such as placenta or amniotic fluid abnormalities, she said. There "may be a high risk of fetal demise with infections in the last trimester," she said. The finding that nearly 30 percent of Zika-infected women had an abnormality on their ultrasound is "worrisome," the researchers said. They note that the rate of fetal death in women with Zika was 4.8 percent, which is about twice the rate of fetal death among women infected with HIV living in the same area. However, Adalja said that because the new study was small and in a single area, more studies are needed before researchers know the true rate of Zika-related pregnancy complications. In addition, there were 30 women in the study who were infected with Zika but did not have an ultrasound. It will be important for future studies to perform ultrasounds on all Zika-infected women in order to generalize the findings, Adalja said. [The 9 Deadliest Viruses on Earth] In Brazil, fears about Zika are running very high, Nielsen-Saines said. "People are very worried, there is a lot of fear and concern" she said. Some pregnant women who become infected with the virus are coming to doctors and requesting to have their labor induced right away – some in the third trimester, but also some still in their second trimester -- in hopes of minimizing the damage to their fetus, she said. The study is published today (March 4) in the New England Journal of Medicine. 5 Things to Know About Zika Virus Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Hillary Clinton's doctor diagnosed the presidential candidate with pneumonia on Friday, according to The New York Times. But while the illness may evoke images of cold weather, experts told Live Science that a late summer case of pneumonia is nothing surprising. Pneumonia, which is characterized by inflammation in the lungs, can be caused by bacteria, a virus or a combination of both, said Dr. Amesh Adalja, an infectious-disease specialist and a senior associate at the University of Pittsburgh Medical Center's Center for Health Security. Adalja has not treated Clinton. [7 Absolutely Horrible Head Infections] There is some seasonality to many infectious diseases, Adalja told Live Science. For example, certain viruses which can cause pneumonia are more common in summer than they are in winter, Adalja said. Pneumonia can be caused by a number of other things, including fungal infections, parasites or reactions to certain medications. With any disease, seasonality represents only one common pattern of infection. That means it is possible for a person to get a certain illness outside of that season, he added. Dr. Len Horovitz, a pulmonologist at Lenox Hill Hospital in New York City, who has not treated Clinton, agreed. Just like there are winter colds and summer colds, caused by different viruses, a person can get pneumonia in the summer or the winter. Although The New York Times reported that Clinton is currently taking antibiotics for the pneumonia, Horovitz said that he suspected the candidate's pneumonia was caused by a virus, rather than bacteria. Antibiotics would not treat a viral infection, he said. When people have bacterial pneumonia, they're a lot sicker than people with viral pneumonia, Horovitz told Live Science. Bacterial pneumonia often requires hospitalization and intravenous antibiotics, Horovitz said. Still, it's not uncommon for a doctor to start a patient on oral antibiotics, especially when the patient has walking pneumonia, Horovitz said, referring to the type of pneumonia that involves not being stuck in bed. Doctors prescribe antibiotics in case a patient does turn out to have a bacterial infection. Although such infections can be confirmed by testing a person's sputum (a mixture of saliva and mucus) for bacteria that could cause pneumonia, it can take several days for the test results to come back, and by then, a person could be quite ill, he said. Walking pneumonia is very common, Horovitz said. He noted that in his practice, he sees it all the time. Because the illness is not serious, doctors don't need to report it to the Centers for Disease Control and Prevention (CDC), Horovitz said. When the CDC talks about the nation's pneumonia cases and statistics, they're talking about the more serious cases that require a person to be hospitalized, he said. "There's no obligation to report walking pneumonia [to the health department] any more than you'd have to report a common cold," Horovitz said. The condition is about as contagious as a cold, he added. Walking pneumonia is like a "chest cold [that's] gone a step further," Horovitz said. The treatment for a viral version of pneumonia includes staying hydrated, getting rid of mucus from the throat and lungs (by coughing it up, for example) and getting enough sleep, he said. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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