Shares

Some weeks I have time to dedicate my blogging efforts to a thorough discussion of one specific topic, and some weeks I just don’t. Fortunately, I came across a few newsworthy items that I think readers will be interested in, and only one of which involves drinking dog urine for its medicinal benefits. Welcome, once again, to yet another Miscellany of Medical Malarkey.

Measles continues to spread across Europe and people are dying

Thanks to a growing anti-vaccine movement and decreasing immunization rates, cases of measles have been on the rise throughout Europe. And despite the frequent claims from some anti-vaccine propagandists that it is a mild infection in healthy individuals with good nutritional status who are replete with vitamin A, implying that it’s fine for poor people in developing regions to suffer and die, in reality it is an infection with serious potential for morbidity and mortality. But don’t take my word for it.

In February, The New York Times reported that measles cases throughout Europe quadrupled in 2017 with over 21,000 recorded cases. I’m sure it goes without saying that this is almost certainly a significant underestimate of the actual numbers, and I’ll tell you why that really matters shortly. The largest outbreak took place in Romania, which had more cases in 2017 than in all of Europe the previous year.

Italy was a very close second with around 5,000 cases, Ukraine just a few hundred less than that, and several other countries had large outbreaks of up to 1,000 cases, including Belgium, Britain, France, Germany, Greece, Russia, and Tajikistan. Just under half of the reported cases were in children under the age of 15 years, but the single most effected demographic were children under a year of age. As expected, virtually all reported cases involved individuals who were not vaccinated or who had not received the full series. So the fact that these countries tend to have the highest levels of “vaccine skepticism” isn’t a coincidence.

But how many died from this “mild infection” that according to vaccine science deniers should run its course uneventfully in patients living in developed countries? I found a couple different answers, but most of the reporting and WHO data was somewhere in the 30-50 range. Most of these were in children, as would be expected.

In addition to the people of all ages that succumbed to the initial infection, we can also expect the eventual death of many of the young children that recovered in the years to come. This will include kids who had milder infections and weren’t officially diagnosed. This second round of deaths will come in the form of subacute sclerosing panencephalitis (SSPE), a horrific, slow-yet-steady cognitive decline that ultimately results in death. I’ve written about SSPE before. To be clear, there will be children and young adults years from now who begin having mild cognitive impairment that will, over several months, slowly progress to death.

The 2017 measles outbreaks across Europe have continued into 2018. In France, to give just one example, there have been roughly 2,500 cases since November. 88% of these patients were not fully immunized and about 1 out of 4 have required hospitalization.

This is France, which has better healthcare than the United States and a generally healthier population. Unfortunately, French health authorities announced that there is no region in the country that can boast levels of vaccine uptake that would provide proper herd immunity so they are primed for a major outbreak. Just this week, they announced two more deaths.

And while I realize that Papua New Guinea isn’t in Europe, and that Steve covered this in a post earlier in the week, I’ll still shoehorn in the announcement of polio cases popping up 18 years after the country was declared free of it. This is very scary stuff.

As many babies die unexpectedly during sleep in the United States every year as all pediatric motor vehicle fatalities combined

As a parent of young but rapidly aging* children, one of my greatest anticipated worries is the day that they are able to get behind the wheel of a car. I won’t be the first parent to lose sleep over this concern and I certainly won’t be the last because cars are terrifying death machines that kill thousands of people every year. We are constantly bombarded with reports of these accidents by our local news outlets, and many people can relate to this concern through personal experience.

But as a pediatrician, particularly one who primarily cares for newborns, the specter of sleep-related death haunts me as well. I spend a significant amount of time with each family discussing safe sleep practices that have been proven to reduce the risk of death during sleep, the most commonly known presentation being SIDS. SIDS deaths, however, are just one component of the total number of sudden unexpected infant deaths (SUID) that occur every year.

Unfortunately, the literature is confusing because historically different terms have been used in a haphazard manner to catalogue these deaths. In order to improve our ability to draw conclusions from the data, there has been a move to try to stick with SUID as a global category and then break it down from there. Only recently has there been the creation of a CDC registry to keep track of SUID cases, but only 16 states are currently contributing.

In a recent JAMA Pediatrics Viewpoint, three experts in the Rush University Department of Pediatrics call for more support for efforts to create a comprehensive SUID registry. They believe such a database can better guide research and help fine-tune public health efforts, and they use the dramatic drop in pediatric motor vehicle fatalities over the years as an example of how successful this approach can be. They point out that this is necessary because, after initial reductions in sleep-related deaths when the AAP and NIH endorsed Back to Sleep program was rolled out in 1992, there has been a plateau at around 3,700 yearly cases since 1999. This is equivalent to the current number of yearly pediatric deaths from car accidents.

One of their concerns, and I absolutely agree, is that many parents just don’t seem to take the risk as seriously as they should, and they may not be strictly following recommended safe sleep practices because of it. This may in part be because these deaths are not reported publicly in the same way that pediatric traffic fatalities are, giving a false sense that they are very rare. I’ll add that there is also a worrisome amount of science denial and misinformation available online regarding the risk factor of sharing a bed with young infants.

Consuming raw milk is dangerous, especially for kids

Earlier in the month, news of several children in Knox County, Tennessee being hospitalized with severe E. coli infections made the rounds. Many of the cases, and in particular the two toddlers featured in the news reports, were linked to the consumption of raw milk from a local farm. They were extremely ill and required ICU admission for management of a very dangerous potential complication, seen when children are infected with certain toxin-producing strains of the bacteria, known as hemolytic uremic syndrome.

HUS is serious stuff. I’ve been involved in the care of three children with HUS in my career. One died, one survived with permanent cortical blindness, and one had a full recovery. The two children in this story both developed kidney failure requiring dialysis, and needed multiple blood transfusions. One had a staph infection of his central line that complicated his course. Both are now home and continue to have residual kidney injury as of the latest report I could find.

The father of the two children admitted to being completely unaware that raw milk could result in such severe illness. This is unfortunate because that information is readily available through the CDC and numerous other trustworthy sources of medical information, not the least of which should have been the children’s pediatrician or family doctor. More unfortunate is the fact that the family had signed up for a “cow-share” program, which is perfectly legal while selling raw milk at a store is decidedly not, because they had read about health benefits of avoiding pasteurization.

This is dangerous misinformation. There is absolutely no health benefit experienced by consuming raw milk over pasteurized, only risk. It makes no sense to me that these cow-share distribution systems are legal. Thankfully the family is now speaking out about the risks of raw milk consumption, a refreshing outcome considering the response of Ezekiel Stephan’s parents to their child’s death by worldview.

Finally, medicinal dog urine?

Yes, it’s a thing. Not that there are medical benefits, just that apparently some people believe that there are. The woman in question collects a clean catch specimen of her clearly well-trained pooch’s urine every morning, topped off by the neighbor’s dog if supplies are limited, and down it. She claims that it has given her perfect skin, cured her depression, and prevented cancer since she began this routine two years ago. I feel compelled to point out that she has also not been attacked by a bear in the past two years.

She began drinking dog urine after reading a decades-old study that discussed antibodies being found in human urine, although I doubt she just stumbled on it. The interest was probably already there. She also says something about a Big Pharma conspiracy but it doesn’t really matter why though, does it? Urine therapy, even using animal urine, isn’t new but it certainly isn’t mainstream. It’s pretty ridiculous actually.

There obviously isn’t any good evidence that it is beneficial in any way to drink urine. There is, however, good reason to consider not drinking it, especially canine urine. Leptospirosis, a serious infection that can cause meningitis and organ failure, can be spread through exposure to dog urine. Wait, the neighbor’s dog? How do you start that conversation I wonder?

See you next time.

*To be clear, my children are aging at the normal human rate. They aren’t Benjamin Buttoning. It is my false perception of the passage of time that gives me the impression that they are gaining at least two years to my one.