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Don't Panic About the Plague

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If reports of measles and whooping cough making a reappearance aren't alarming enough, the news that three people in New Mexico have contracted plague this year might have you on edge. But these aren't the only recent cases of plague in the state—the disease appeared in both 2016 and 2015, causing one death—or even in the U.S.

In 2015, a child contracted the plague in Yosemite National Park, and so did a tourist from Georgia; park officials closed a campground where they discovered two dead squirrels infected with the disease. That same year in Colorado, a pitbull infected four humans with pneumonic plague before being put down, and two other Colorado residents died from plague, including a 16-year-old boy.

It all seems very scary, but don't go sealing yourself in protective gear yet. There's less to fear about plague than you may think. While the public is prone to panic that a medieval illness, which wiped out a quarter of Europe in the Middle Ages during the Black Death, has suddenly arisen from obscurity, the truth is: Plague never left.

Though we haven't seen a widespread epidemic of plague since the early 20th century, thanks to advances in sanitation and medicine, and there hasn't been a human-to-human case of transmission in America since 1924, an average of seven new cases are reported every year in the U.S. From 2010 to 2015, there were 3248 cases, including 584 deaths, reported worldwide, according to the World Health Organization.

Yersinia pestis, the flea-borne bacteria that's most often responsible for plague, infects rodents; humans are “incidental hosts,” who can acquire the infection if bitten by an infected flea or rodent. Compared to the 14th century, when the Black Death spread wildly, or the late 19th century, when 10 million people died of the disease after it traveled from Hong Kong to port cities worldwide, most people today live in more sanitary conditions and have less frequent contact with the rodents most likely to carry the infected fleas. Today, 95 percent of plague cases originate in parts of sub-Saharan Africa and Madagascar.

The most common of the three strains of plague is the notorious bubonic plague, which causes painful swollen lymph nodes (also called buboes) and was responsible for Europe's Black Death—so named because internal hemorrhages caused by the infection make the skin appear black. But the pitbull that infected four Colorado residents carried the rarer respiratory strain of pneumonic plague, which is contagious when the infected person coughs up infected particulates. There is also septicemic plague, the most lethal form, which infects the blood, and most often occurs when plague virus has gone undetected and is allowed to spread.

In the U.S., you're generally only at risk of contracting plague in late spring to early fall if you've been in a rural or semi-rural area of the West, especially New Mexico, Arizona, or Colorado, and have had contact with fleas or rodents including ground squirrels, chipmunks, prairie dogs, or rats. And even then, the risk is low.

Only the pneumatic version of plague is contagious from human to human (though untreated bubonic plague can become pneumonic), but you have to be coughed upon, or receive fluid from an infected person upon an open wound or directly into your mouth or nose.

Plague symptoms mimic any flu—fever, chills, headache, difficulty breathing or coughing—but people have been known to cough up blood with the pneumonic variety. If you've been in a rural area, or camping, and come down with these symptoms two to three days later, it's best to go to a hospital.

Now for some good news: While untreated plague is quite deadly, people with plague who are treated with antibiotics within 24 hours of infection have strong recovery rates.

So while it's good to be aware and take precautions, the chances of another plague pandemic remain slim.

This story was originally published in 2015 and has been updated. 

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Big Questions
What Is the Difference Between Generic and Name Brand Ibuprofen?
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What is the difference between generic ibuprofen vs. name brands?

Yali Friedman:

I just published a paper that answers this question: Are Generic Drugs Less Safe than their Branded Equivalents?

Here’s the tl;dr version:

Generic drugs are versions of drugs made by companies other than the company which originally developed the drug.

To gain FDA approval, a generic drug must:

  • Contain the same active ingredients as the innovator drug (inactive ingredients may vary)
  • Be identical in strength, dosage form, and route of administration
  • Have the same use indications
  • Be bioequivalent
  • Meet the same batch requirements for identity, strength, purity, and quality
  • Be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator products

I hope you found this answer useful. Feel free to reach out at www.thinkbiotech.com. For more on generic drugs, you can see our resources and whitepapers at Pharmaceutical strategic guidance and whitepapers

This post originally appeared on Quora. Click here to view.

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Health
8 Potential Signs of a Panic Attack
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It's not just fear or worry. In fact, many panic attacks don’t look like panic at all. Panic attacks come on rapidly, and often at times that don't seem to make sense. The symptoms of panic disorder vary from person to person and even from attack to attack for the same person. The problems listed below are not unique to panic attacks, but if you're experiencing more than one, it's a good idea to talk to your doctor either way.

1. YOU'RE DIZZY.

Doctors sometimes call the autonomic nervous system (ANS) the "automatic nervous system" because it regulates many vital bodily functions like pumping blood all on its own, without our having to think about it. Panic attacks often manifest through the ANS, leading to increased heart rate or decreased blood pressure, which can in turn lead to feeling lightheaded or faint.

2. YOU'RE LOSING YOURSELF.

Feeling detached from yourself is called depersonalization. Feeling detached from the world, or like it's fake or somehow unreal, is called derealization. Both forms of dissociation are unsettling but common signs that a panic attack has begun.

3. YOU'RE QUEASY.

Our digestive system is often the first body part to realize that something is wrong. Panic sends stress hormones and tension to the gut and disrupts digestion, causing nausea, upset stomach, or heartburn.

4. YOU FEEL NUMB OR TINGLY.

Panic attacks can manifest in truly surprising ways, including pins and needles or numbness in a person's hands or face.

5. YOU'RE SWEATY OR SHIVERING.

The symptoms of a panic attack can look a lot like the flu. But if you don't have a fever and no one else has chattering teeth, it might be your ANS in distress.

6. YOU KNOW THE WORST IS COMING.

While it may sound prophetic or at least bizarre, a sense of impending doom is a very common symptom of panic attacks (and several other conditions). 

7. BREATHING IS DIFFICULT.

The ANS strikes again. In addition to the well-known problems of hyperventilation or shortness of breath, panic attacks can also cause dyspnea, in which a person feels like they can't fill their lungs, and feelings of choking or being smothered.

8. YOU'RE AFRAID OF HAVING A PANIC ATTACK. 

Oddly enough, anxiety about anxiety is itself a symptom of anxiety and panic attacks. Fear of losing control or getting upset can cause people to avoid situations that could be triggering, which can in turn limit their lives. 

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