Posted on 04/12/2006 2:48:21 PM PDT by neverdem
ASSOCIATED PRESS
ATLANTA -- Two infected airline passengers may have helped spread Iowa's mumps epidemic to six other Midwestern states, health officials said Wednesday, the latest example of how quickly disease can spread through air travel.
"These people may have exposed other people on those planes or in these airports," said Kevin Teale, a spokesman for the Iowa Department of Public Health.
The mumps epidemic is the nation's first in 20 years. Health officials say 515 suspected cases have been reported in Iowa, and the disease also has been seen in six neighboring states, according to the U.S. Centers for Disease Control and Prevention.
As of Monday, Nebraska has 43 reported cases; Kansas, 33; Illinois, four; Missouri, four; Wisconsin, four; and Minnesota, one.
The Iowa health department identified two people who were potentially infectious when they were traveling in late March and early April.
Officials in other states have not yet linked any cases to the air travelers. But because the illness's incubation is two to three weeks, cases may not begin appearing until about now, Teale said.
This week the CDC put out an advisory about the passengers to state health departments. "Infectious diseases can travel easily on planes and other modes of transportation," said Dr. Jane Seward, acting deputy director of the CDC's viral diseases division.
The first traveler is executive director of a Waterloo, Iowa, downtown development organization who in late March was in a delegation that traveled to Washington, D.C.
The woman, Terry Poe Buschkamp, had earlier visited the Dominican Republic where she thinks she may have caught the bug. Health officials did not release her name, but she has acknowledged her infection to the media.
Buschkamp, 51, left Waterloo, Iowa, on March 26 on a Mesaba Airlines flight to Minneapolis and then flew Northwest Airlines to Detroit. On March 26, she flew to Washington, D.C.'s Reagan National Airport. During her visit, she shook hands with Iowa's two U.S. senators, Tom Harkin and Charles Grassley, she said.
She returned to Waterloo on March 29 on Northwest and Mesaba flights, with a stop in Minneapolis.
She said she developed a scratchy throat upon her return, and after hearing reports of a mumps outbreak, went to a doctor for testing. She got confirmatory test results six days later.
During those six days, she had been to church and numerous work events, including an April 1 pub crawl that involved about 370 people. Mumps has been a mild disease for most people, but Buschkamp found the length of time she was able to spread the virus before learning her test results alarming.
"That's the real story," she said.
She said two of her fellow travelers have told her they have mumps-like symptoms, but have declined to see a doctor about it.
The second person was a young man returning from vacation in Arizona on April 1, Teale said.
He flew American Airlines, from Tucson to Dallas, then to Lafayette, Ark., to St. Louis and finally to Cedar Rapids, Iowa.
Two people - and nine flights? "It's hard to get anywhere (from Iowa) without connecting," Teale explained.
Mumps is a virus-caused illness spread by coughing and sneezing. The most common symptoms are fever, headache and swollen salivary glands under the jaw. But it can lead to more severe problems, such as hearing loss, meningitis and fertility-diminishing swollen testicles.
No deaths have been reported from the current epidemic.
A two-dose mumps vaccine is recommended for all children, and is considered highly - but not completely - effective against the illness. About a quarter of the Iowans who have suspected cases got the vaccine, Teale said.
I have a teeny problem with this gal from Iowa. She knew she was being tested for an infectious disease, and almost certainly knew it would take several days to get the test results (not uncommon with mumps testing. So, she went all these places and exposed all these people, knowingly?? You can't help exposing people before you are aware that you have something. You don't have to expose the rest of the world once you know there's a good possibility that you're contagious.
Smoke is an irritant, so as long as they allowed smoking on board, they had to exchange the air.
Exchanging the air required fuel.
They tried non-smoking flights, but no one would fly on them - so they lobbied for a federal law to make all flights non-smoking.
No smoke, no air exchange.
No air exchange, the airlines save fuel (and money).
No air exchange, and one passanger with ebola means everyone on the flight will have it, by the time you land.
Sort of like mumps.
Only, most of us are vaccinated against mumps...
Wow, I had no idea that the airlines have completely stopped air exchange.
I'm sure you can back that up, NOT.
Have fun, learn something, get an MSOR, then feel free to talk to me.
Until then, go away.
Last I saw the fraction of those with mumps who'd been vaccinated had been higher than this. However, since Iowa now has more cases of mumps than the whole country has had for awhile I hope the CDC does some good epidemiology on this. I've heard rumors that an alas popular, double alas locally invented "health care" "profession" had been telling parents NOT to get their children vaccinated and supporting their exemptions from the usual school requirements. I'm in the wrong medical specialty to know whether the rumors are true, or to judge how commonly such, IMHO stupid, advice is followed. But if the rumors are true they could explain why we are having such an epidemic in Iowa. The political lobby in Iowa for those rumored is quite powerful so I'd prefer the CDC to investigate so as to have a better chance that the politically incorrect questions get asked and tallied. From what I've read so far this outbreak doesn't seem to be centered on our low tech religious areas like the Amanas so I doubt traditional religious exemptions have contributed much to it.
OK, I'll put it this way.
You are lying, and air is still exchanged on airplanes.
I was working as a Travel Agent at the time Northwest started pushing for a smoking ban. I was working with a male Travel Agent who used to work for Pan Am.
A few years after Northwest went smoke free, he found out that their filters are filthier then they EVER were when there was a smoking section on their planes. They feel they do not have to change the filters as much since there is no smoking. Well, guess what! Can you just imagine all the germs and bacteria that is being pushed back into the cabin from such filthy filters?
And it's not just Northwest today. ALL US airlines were forced to go smoke free, and most of the European carriers as well.
I hope I NEVER have to fly again!
I fly about twice a week, you know. ;)
Same here. Except for private aircraft!!
Wear a face mask. You can get a whole box cheap at Rite Aide. :)
Ok, not to step into the middle of a snit storm.
Air is typically exchanged 50/50, external/recirc in modern aircraft. This is adjustable to 100/0 if the cabin fills with smoke(or bio hazard emergencies) on all modern aircraft. In the 60-70s, the ratio was higher, in the earliest pressurized craft, it was always 100/0. Fuel economy was the reason for adding the re-circ.
Interesting enough, the front turbine compresses the air and it gets hot enough to make it essentially sterile. I would suspect that aircraft flying into and out of hot zones will be 100 external air.
"She said two of her fellow travelers have told her they have mumps-like symptoms, but have declined to see a doctor about it."
But of course they self-diagnose themselves. Now they'll spread it all over.
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A two-dose mumps vaccine is recommended for all children, and is considered highly - but not completely - effective against the illness. About a quarter of the Iowans who have suspected cases got the vaccine, Teale said.
What this means is that the effectiveness of vaccination probably most of us received in childhood has diminishted beyond useful.
Yep.
It is still true that mumps can cause sterility in males.
The latter doesn't follow from the former and reflects, at best, ignorance of statistics. To draw any conclusions on how well the the vaccine is working in the current epidemic you need to know not only how many of the people who got the mumps had been twice vaccinated but also how many of the people who were exposed to the mumps, at thus at risk for it, had been twice vaccinated. If nearly all at risk had been vaccinated the mumps could be 100% contagious in the non-vaccinated and only 1% contagious in the twice vaccinated and still end up with 68% of the infected had been twice vaccinated. I'd consider that a darn good vaccine. My understanding is the mumps vaccine has been 85-90% protective, which is pretty good considering that there is no specific treatment if you get mumps. Yes mumps tend to be relatively mild in children, but most of these cases are young adults. Iowa has been lucky enough to have no deaths yet, but several have been hospitalized and death can occur. Besides even if your life weren't at risk how would you like your family jewels inflated for a week or so? And then have to worry whether there was any future family left in them?
There are some legitimate medical reasons to not be vaccinated, but very few people have them. There are people whose religious faith bars vaccination. Our first amendment gives them the right to make that choice and gives me the right to call them kooks! All the rest who refuse vaccination deserve to be tarred with the same brush as draft dodgers and antiwar protesters. They are freeloading cowards and worthy of our scorn. They are accepting the protection of the herd immunity created by the majority of us who accept the individual risks of vaccination and thus reduce the likelihood that they will ever be exposed to what in the pre-vaccine era would have been a major risk. All the while they are increasing the chance that those of us who chose to defend ourselves with the best available measures, may still be overwhelmed by an epidemic that wouldn't have been sustained had they collectively done their civic duty and joined in the collective defense.
You are full of it.
"If nearly all at risk had been vaccinated the mumps could be 100% contagious in the non-vaccinated and only 1% contagious in the twice vaccinated and still end up with 68% of the infected had been twice vaccinated."
There is no way to test who has been exposed and who hasn't. The silly postulate you put forward is only useful in a statistics lab, therefore what you said was ridiculous. Sure the mathematics of it works but it explains nothing in the real world.
They test a local population under the assumption that the exposure is more or less uniform. Sure, it's a lousy way to do it but that's the best they can do -- unless there is a sheltered population, like some Amish communities.
" My understanding is the mumps vaccine has been 85-90% protective"
How do you think they came up with that 85-90% number? Duh. The same way they came up with the 68% number they are using now, from a local population study.
I'm physiologically-sensitive to that kind of stuff, having had terrible asmtha as a child. Three-quarters of the way into a 7-8 hour flight I'm ready to die. And the problem has become worse in the past ten years or so. I dread flying for this reason alone. I also wonder how many air-rage incidents are aggravated by this kind of stuff.
| Vaccinated?: | Yes | No | Totals | % vaccinated |
| Got mumps | 13 | 7 | 20 | 65 |
| No mumps | 77 | 3 | 80 | 96 |
| # exposed | 90 | 10 | 100 | 90 |
| % mumped | 14 | 70 | ||
| % 'protected' | 86 | 30 | ||
I don't think my only numerical assumptions, the vaccine protects 86%, 90% got it and without it 70% of those exposed got mumps are unreasonable. With chicken pox the later number would be about 95%. Yet it gave for the % of those who mumped who were vaccinated as 65%, nearly the 68% you'd cited. You wrote, "Sure the mathematics of it works but it explains nothing in the real world." If you do the statistics properly, the math describes the real world. Would you consider this table a good commercial for the mumps vaccine? If the intended audience were math literate, I would. If the intended audience weren't I wouldn't expect them it understand it. E.g., normally I'd assume it was good for FR, hopeless for DU.
There is no way to test who has been exposed and who hasn't. The silly postulate you put forward is only useful in a statistics lab, therefore what you said was ridiculous.
Contact tracing to determine who has been exposed is bread and butter public health work. It's done routinely for STDs, TB and other serious diseases. It is labor intensive and thus expensive so is less often done for large outbreaks of less severe disease. It could have been done in the early days of the US HIV epidemic, but was quashed by the libs. I've heard some PC AIDS experts admit now it might have worked then to limit the epidemic. The media reports it has been done, at least partially, in this mumps epidemic! Two cases flew commercially and they tried to reach all the other passengers.
How do you think they came up with that 85-90% number? Duh. The same way they came up with the 68% number they are using now, from a local population study.
Yes, a local population study with a defined population of who was at risk. To get the 68% (65 in my example table) you only need to count those who mumped and ask them whether they'd been vaccinated. But to get the 85-90% number (my 86) you needed a numerator, how many were vaccinated and mumped, and a denominator, how many were vaccinated and exposed. The latter being what you said "There is no way to test..." No denominator, no % protective number. Duh. I don't deny the numbers may be a bit fuzzy, but you have to have some kind of a number. Even how many have mumps may be a fuzzy number as the diagnoses aren't always certain. With a big enough, honest, sample the fuzz tends to cancel out the statistics become useful.
Now I breezed by a nonnumerical assumption, that the population exposed was immunized the same as the whole statewide population. Whether or not it is potentially interesting as could be why it is not. Such was the reason for my original posts on this subject. This, the largest US mumps outbreak in 5 years, might offer enough statistical power to answer the question. If there isn't sufficient statistical power available in this outbreak, something the public health folks can quickly determine, then there's no point in asking the question. Did the recommendations of Chiropractors, a group very popular and founded in this state, actually founded in my community, some of whom routinely oppose vaccination (I have no ideas of how many are 'shot' vs. 'no shot' in their advice) encourage this epidemic or not. Either may be true. The 'no shot' advice is controversial in medical circles, and given that they have two camps on it I presume it is also controversial in Chiropractic circles. The feedback, pro or con, would help all concerned.
Except when the disease arrive by "coyote" !
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