S8 E3: What's New with WHO? Updates in Epidemiology

0:00 The Missing Magnolia's podcast tells the stories of the missing and murdered. Ultimately, these kids went to Saint Hussy and they never came out. Together with Missing Persons expert doctor Michelle Jahni's we uncover the real true crime experience. Every time we do another interview, I'm like, how do we find so many badass women? We hear from victims who turn their pain into something positive. We didn't find out two we're eleven or twelve years old that our mom was murdered in Times Square. It said Mickey Schuenich fought for her life. An experts who think outside the box to sell cases. Nice scour missing Person's database is like namous to see if they're uploaded to that database. Subscribe to Missing Magnolia's on Apple, Spotify, or wherever you get your podcasts today. Well, hello there, I'm Regina King, the Evil Queen, and I'm Lynn Rosskamp, Dosent of Darkness, and we're the hosts of Disturbing Interests. Do you get excited about mummies? Decorate in skulls, obsess over the loss of the Library of Alexandria even though it was lost in a different age. Do you kill the conversation with your in depth serial killer knowledge, facts about items made out of human skin, or have a strange longing to know the softer side of Mothman. Have you spent an objectively disproportionate amount of time studying the life of Ajhlmes? Oh, I wouldn't know anybody like that. No, certainly

1:34 not. Well, I mean we did call our podcast disturbing interest for a reason. That's right. We've got them, and we are doing you the favor of keeping the questions like at what temperature does it take to destroy a cadaver out of your browsing history. Well, we hope, because with us, you might be disturbed, but you're not alone. You can find us on any podcasting platform under Disturbing Interest, or check us out online at disturbing interest dot com. Welcome to Creepy Tapas, the show where two spooky best friends give you tiny tastes of terror connected by a common ingredient. We serve up movie reviews, mysteries, murder, mayhem, and tantalizing tales from the depths of the Internet, and some random bullshit too, all focused around a similar theme. We blend our love of horror, oddities and general creepiness and dig a little deeper, discovering the history, psychology, and truth behind your wildest fears. Join us Ash and Jordan as we descend into full darkness.

2:40 Every Sunday, wherever you listen to podcasts, it's creepy tapas, y'all? What what crowd? Members of the dark Cast Network. Darkcast Network, come on over to the dark Side. We're really nice people once you get past the true crime and scary science. Hello, and welcome to Cause of Death one hundred seconds to midnight. I'm your host, Jackie Morante. I wanted to take a moment to discuss some recent happenings in the world of epidemiology.

3:20 I'm going to talk about some diseases that I've addressed in previous episodes and some that I haven't touched on yet, but all of them have been in the news recently. I won't be getting into the ideology and pathology of these diseases in this episode. If I haven't talked about some of these yet, they're on the list, so I'll address that when the full episode drops. There have been recent updates on the mystery disease that's affecting dogs in nineteen states, confirmed cases have been reported in California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Massachusetts, New Hampshire, Nevada, Oregon, Pennsylvania, Rhode Island, Maine, Texas, North Dakota, Vermont, and Washington State. The cause of a typical canine infectious respiratory disease complex is still unknown and researchers are still trying to find the cause through DNA testing.

4:23 In November of twenty twenty three, two hundred cases were reported in Oregon, and most of these were in the Portland area. Veterinarians are urging people to limit their dogs social lives, including doggy daycares, boarding facilities, dog parks, and even dog shows. Several shows have been canceled to prevent the spread of the disease. The symptoms of the disease mirror kennel cough and include cough, fever, and lethargy. The animals may also exhibit sneezing and watery eyes. The main concern with this disease is that it often leads to pneumonia, and there have been fatalities. According to doctor William Hagen's, a veterinarian at the Town and Country Animal Clinic in Hazard, Kentucky. Quote, this new respiratory disease is starting to present with more symptoms, more severe and they meaning the dogs decline more rapidly than your typical kennelcloth patients would end quote. Vets are still recommending that dogs are updated on all vaccinations and they urge puppy parents to take an extra measure with a booster of bordtele vaccine and canine influenza.

5:45 While the true causative agent is still unknown, the University of New Hampshire's Veterinary Diagnostic Laboratory has said that it may have identified a bacterium that is responsible for the illness, based on genetic SCIS sequencing of samples taken from thirty dogs who had presented with the illness in twenty twenty two and forty more from Rhode Island and Massachusetts in twenty twenty three. David Needle, chief pathologist at the diagnostics lab, has described the bacterium as lacking a cell wall and being smaller in size than a normal bacterium. He believes that it may be a member of the normal flora that grows in the respiratory tract, but it has developed a virulence associated gene trait. There is some good news for dog owners, though in many states the incident's rate is declining. Colorado, which had one of the highest rates of illness in the country, has reported fewer cases of the disease, according to a representative at the Colorado State University School of Veterinary Medicine.

6:57 Veterinarians at Coloratto State aren't sure whether this is because the disease is running its course or it's because people are keeping their dogs home and limiting their social interactions. Another bright spot in this is that the disease is showing no sign of zoonotic potential. It hasn't jumped to humans. Speaking of zoonotic potential, avian flu H five and one has made its way to dairy, cows and cats. I talked a lot about av and flu in season two, episode six. That episode was called playing Chicken with a train. If you want to know the ins and outs of avian flu, it's all right there.

7:42 Eight herds in Texas, three in Kansas, two in New Mexico, and one herd each from Idahom, Michigan, and Ohio have been confirmed as infected with avian influenza It's unclear how the herds were infected. The cows may be passing it from cows cow, or it could be related to insufficient cleaning of milking equipment during milking. There may also be risk associated with the transportation of cattle from winter grazing grounds to summer grounds. It is suspected that the birds infected the cattle when they left droppings in the feed or water. Bird flu has also been known to travel in the wind from chicken farm to chicken farm.

8:28 The infected felines were found in Texas. When veterinarians came to the farm to treat the cattle, they noticed that cats were also sick and took samples from them. Infections and cats have been previously reported in the US, Poland, and South Korea. Cats and pigs are among the few species of mammals known to contract H five N one. The CDC announced that the first human infection linked to dairy cow exposure was confirmed. The patient was a worker on one of the dairy farms, so had constant contact with the sick cattle. The infected animals all seem to be recovering well with the help of anti viral medication and the human patient is also recovering. Epidemiologists have found no evidence of human to human transmission from the infected worker. Now, let's talk about what this means for milk production and the food chain. Milk infected with H five one has been found post production. As far as I can tell, this milk was tested prepasteurization, but the producers destroyed the milk so that it wouldn't get into the food chain. The threat to humans remains low, largely due to the pasturization of milk. This virus is heat sensitive and pasteurization will kill it. If the virus should make its way into beef cattle, cooking will

10:00 kill it. It's the same thing that I always say, cook your meat well and make sure that any dairy products that you ingest have been pasteurized. The CDC is keeping an eye on the gene sequence of the current H five N one strain, which has mutated a bit, but not enough to be considered concerning. The various strains of avian influenza have been put into a database called next Strain, which allows researchers to map the family tree of virus sequences. This tool will be invaluable as time goes on and the virus mutates further.

10:43 Okay, so now that I've ruined your dog's social life and you're going to be asking about pasteurization at your favorite ice cream shop, let me ruin your sex life as well. Syphilis is skyrocketing in the US. The numbers haven't been this high since nineteen teen fifty. I'm planning a whole season on sexually transmitted infections, and syphilis will be among those. For now go with you really don't want this disease. While overall STIs declined one percent between twenty twenty one and twenty twenty two, the infection rate of syphlis rose seventeen percent and congenital syphlis rose thirty percent over that period. Numbers for twenty twenty three have not been released yet, but it would be prudent to surmise that the numbers haven't gone down much, if at all. Reports of syphilis in twenty twenty two reached epidemic proportions with two hundred and three thousand, five hundred cases.

11:48 Rates of congenital syphlis resulted in two hundred and thirty one still births and fifty one infant deaths. The uptick in the infection rates have been to substance use, which is tied to risky sexual behavior, and better prevention of HIV, which has led to fewer people using condoms. The main reason for the rise in the disease is the lack of sexual health care clinics in the US. Doctor J. Varma, chief medical officer at Psyga Technologies and former Deputy Commissioner of Health in New York City, told The New York Times quote, when you miss one case, then you end up with two more cases.

12:33 And if you miss two cases, then you end up with four. That's how epidemics grow. End quote. South Dakota has the highest infection rate, followed by New Mexico, Arkansas, Oklahoma, and Mississippi. Gonorrhea and Syphlis are often asymptomatic, so there are cases that have gone undetected since the carriers haven't been screened for the disease. About eighty six percent of Syphlis cases were diagnosed outside of sexual health clinics in twenty twenty two. This suggests that primary care physicians, emergency departments, community health centers, and correctional and drug treatment programs need to screen for the disease. If left untreated, syphlis can cause severe damage to the heart and brain. It can lead to blindness, deafness, and paralysis. Congenital syphlis leads to miscarriage and stillbirth. Infants who survive are often blind, deaf, or have severe developmental delays. Of course, I can't talk about epidemics without the honorable mention of COVID nineteen. There isn't much out there on COVID nineteen anymore, but who is currently working to downgrade COVID nineteen from immer urgency management to longer term disease management. Overall, in

14:05 the past month, seventy six countries reported new COVID nineteen cases and forty six reported deaths from the disease. Between the fifth of February and the third of March, reported cases and deaths have decreased by forty four percent and fifty one percent, respectively. It's not time to kiss COVID goodbye yet, though, since many countries have changed the way they report the disease, it's come to light that COVID nineteen cases are under reported. I feel like this is the trend with any infectious disease. It certainly happened back in twenty twenty when we were under quarantine. Many cases went unreported then and that trend will continue.

14:52 Currently who is tracking five variants of interest and three variants under monitoring. It's still to proceed with caution, but it seems that as mutations become less virulent, severe cases and cases of long COVID are decreasing. We're going to take a quick break to hear from our sponsor, then we'll be back to talk about Alzheimer's and some exciting news on that disease. Spring is coming and I'm preparing my garden beds and pots for growing. Soon. I'll be starting seeds and you know where I'll be headed for all my supplies. That's right, I'm going to True Leaf Market. I'm pretty new to growing, and this year True Leaf Market has added a new tool to their website to help me grow like a pro. It's the seed Finder Quiz. I love this.

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17:41 Head to www. Truleafmarket dot com and use promo code COFD ten at checkout for ten dollars off any purchase of fifty dollars or more with free shipping in the lower forty eight States on purchases of over seventy five dollars. Go get your grow on with true Leaf market. Diseases like Alzheimer's and als aren't really in my wheelhouse, so I'm not sure that I'll be addressing them in future seasons. It's not that they're not interesting or worthy of explanation. It's more that I don't feel that I know enough about them to give an honest and clear report on them. In this case, I felt that recent discoveries were worth mentioning since it's very exciting news. There have been some breakthroughs on the Alzheimer's front, and the news is both good and bad. In the past few years, monoclonal antibodies have shown promise as amyloid inhibitors. Amyloid plaques are the buildup of amyloid in the brain, a hallmark of Alzheimer's disease.

18:52 There are currently almost two hundred Alzheimer's drugs in active clinical trials, but only three have gotten FDA approval in recent years. The first was agucanu map registered as Agihelm, approved in twenty twenty one. This drug targets amyloid plaques that build up in the brain. The FDA approval of this drug came under the scrutiny of a US oversight committee after its approval. Several findings were made by the committee. The committee found that the FDA didn't document every meeting or exchange that took place between FDA and Biogen while the approval process was happening. This is a major breach of protocol for any company or agency. If you didn't document it, it didn't happen. Or if you didn't document it, what were you hiding. They also found that the FDA collaborated with Biogen on a joint briefing document or the PCNs Advisory Committee. At the time this briefing was prepared, the FDA had differing opinions on the safety and efficacy of agiehelm, and a consensus was never given prior to FDA and Biogen working on the document.

20:19 The third thing they found was that the FDA allowed Agehelm to be approved under an accelerated pathway, the traditional approval pathway would have included review for nine months. The FDA approved the accelerated pathway, which allows review of data for three weeks. This decision was made after an expert council meeting resulted in an unfavorable feedback for the approval of the drug. The next finding was that the FDA approved and Biogen accepted a broad label indication for the drug, despite a lack of clinical data on all Alzheimer's disease stages. What this means is that the FDA approved Agiehelm for treatment of people with Alzheimer's disease. They didn't specify what stage of the disease. The patients who participated in the clinical trials were only in the mild cognitive impairment or mild dementia stage of the disease. Biogen did tell the FDA that they had reservations about accepting the broad label, but it wasn't until patients and providers began questioning the use of the drug and Biogen came under fire after the drug came to market. The following three findings were all related to the cost of Agiehelm. Biogen set an unjustifiably high price for

21:51 Agiehelm in order to make history for the company. Despite the impact on patients and the Medicare program. Biogen expected Agehelm to be a burden to Medicare and costly to patients, and finally, Biogen planned to spend billions to market Agehelm despite the financial impact on patients and the healthcare system. The initial price of Agiehelm was set at fifty six thousand dollars a year. Despite the lack of demonstrated clinical benefit in a broad patient population, Biogen was aware that the financial burden would fall primarily on Medicare. Eighty five percent of the drug's target population would be covered by Medicare, and by the end of the day, Biogen calculated that Agihelm would cost Medicare twelve billion dollars in one year. Out of pocket costs for patients would be twenty percent of their income. When it all shook out, the FDA came under scrutiny, as did Biogen. Anjihelm will be discontinued in twenty twenty four, and in the meantime, Biogen continues to work on other monoclonal antibodies that target amyloid plaques. One of these is lacnamab, registered as Lakembi. This is the latest medication granted full approval by the

23:26 FDA. This drug was created as a collaborative effort between Biogen and SSA, a Japanese pharmaceutical company. This drug went through the traditional pathway for approval and indications and warnings are clearly spelled out on the label. While still very expensive, Lekemby is half the price of agiehelm Eli. Lilly is also seeking approval from the FDA for its drug, the nanomab, for Alzheimer's patients, and as more drugs are approved, the price tag will go down. I wanted to talk about this because I want my listeners to know that there are failsafes in place when drugs are approved. The FDA doesn't have the final say on approval. Drugs go through rigorous testing before they even get to clinical trials.

24:22 Preclinicals take years. It's expensive to get a drug to market, and that expense is passed along to the consumer. But drugs also should be priced so that people don't have to make the choice between eating and getting the medicines they need. Bi Agena is a reliable company, but like many others, they got overly ambitious Agiehelm was the first Alzheimer's drug to be approved in the US, and this prompted FDA to push it through. Agie Helm isn't a dangerous drug, but it was labeled improperly. None of the drugs currently in the approval stages will cure Alzheimer's, and none of them are approved for people in the later stages of the disease. It's important to know that these drugs will prolong the quality of life by four to six months, giving patients more time to spend doing the things that they love to do and giving them more time with their families. Research is ongoing, and one day there may be a cure for Alzheimer's. These drugs are only the beginning. There are a ton of updates out there, and there just isn't time in the day to cover all of them. I chose these because they give a deeper look into not only infectious disease, but also into cures and approvals. Often there is no

25:59 clear path when it comes to disease and it's spread. Several things factor in when we talk about epidemiology. Do we know what causes the disease? Can we prevent or cure it? Has the genome of the pathogen changed, Are there resources available to diagnose it? Where did it start? And where is it going? How can we track it? These questions can be rabbit holes that may lead researchers to incorrect conclusions. When that happens, it's back to the drawing board to figure out where they went wrong. It takes time to correct mistakes, and often those mistakes become public before we know the information is incorrect. This causes confusion and mistrust from the public. On the research side, we learned a lot from COVID nineteen. The next pandemic may see a much slower response. I'm not sure that that's the right answer, but it may keep the insanity at bay. Thank you all for listening to Cause of Death one hundred seconds to midnight. Check out the show notes for more information on the topics that I talked about today. You can also find the link to my sponsor this month, True Leaf Market. Go get your grow on with True Leaf Market. Please don't forget to rate, review and subscribe to

27:29 the show. If you'd like to support the show monetarily, you can find my Patreon page at patreon dot com slash Jackie Morante. There are several levels you can join there, and I'll have different benefits. Everyone who subscribes on Patreon gets AD free episodes. I'm a little behind on sending merch out, so bear with me. There's been quite a bit going on in my life personally, and I just haven't made it to the post office. Apple Subsist Descriptions is also available for those who would rather support the show that way. There you can get AD free episodes and bonus content. I'm playing catch up, so there will be another episode coming out next weekend on Toxoplasma GANDHII.

28:18 My third podversary is coming up this month. Also. I'm working on that episode now and it promises to be super entertaining. I hope you'll listen in on that one until next week. Limit your dog's social lives, and make sure your milk is pasteurized.