One-third of children in Zika virus study show developmental problems

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“Children who were exposed to Zika during their mothers’ pregnancy need to have developmental assessments over time, and eye and hearing exams should be performed,” said lead study author Dr. Karin Nielsen-Saines.

July 10, 2019 | HealthDay New

Researchers say that children exposed to Zika virus in the womb should be screened for effects of the virus. File Photo by mycteria/Shutterstock

New research shows that neurological damage for babies who were exposed to the Zika virus while in the womb continues to unfold years after birth.

Developmental problems were found in one-third of the 216 children studied, some of whom were 3 years old. The problems affected language, thinking and motor skills development. Some also had eye and hearing issues.

Surprisingly, the researchers also discovered that fewer than 4 percent of the children had microcephaly — a smaller-than-normal head that is one of the hallmarks of Zika exposure in the womb. And in two of those cases, the head actually grew to normal size over time.

“Children who were exposed to Zika during their mothers’ pregnancy need to have developmental assessments over time, and eye and hearing exams should be performed,” said lead study author Dr. Karin Nielsen-Saines. She is a professor of clinical pediatrics at the University of California, Los Angeles.

“If there is risk of developmental delay, or developmental delay is identified, there are cognitive, language and behavior interventions that can be put in place to improve outcomes for these children,” she added in a university news release.

The finding that some children born with microcephaly went on to develop normal head circumference by age 1 means that “microcephaly is not necessarily static,” Nielsen-Saines said.

The study was published July 8 in the journal Nature Medicine.

The researchers noted that they didn’t have a comparison group of non-exposed children who were born at the same time and raised in the same settings as those known to have been exposed to Zika in the womb.

“Zika exposure can be a very difficult condition to diagnose in retrospect, so we can’t rule out undiagnosed Zika infection in a control group of children enrolled at the same time,” Nielsen-Saines said.

“Neurodevelopmental tests should be done simultaneously in similar populations with the same background,” she suggested.

“These children require close attention and ongoing surveillance, so that prompt interventions to improve their development can be provided if needed,” Nielsen-Saines said.

More information

The U.S. Centers for Disease Control and Prevention has more on Zika.

Man sues Casper Marriott, alleging he developed serious infection from bedbug bites

Doctors confirmed that he had MRSA, a form of a staph infection that is dangerous because it is resistant to some antibiotics, as well as other issues related to the alleged bites.

Casper_Star_Tribune

by Seth Klamann | July 8, 2019

A Georgia man has filed a federal lawsuit against the owners of the Courtyard Marriott hotel in east Casper, alleging that he was bitten by bedbugs during a stay there in 2012 and later developed a serious infection to his legs.

Casper_BedBug

In this Wednesday, March 30, 2011 file photo, a bed bug is displayed at the Smithsonian Institution National Museum of Natural History in Washington.  

The suit was filed in federal court last month by Frank Pascarelli, who works for the federal Centers for Disease Control and Prevention, where he “is acutely aware of diseases and infections,” according to the lawsuit. He filed the suit against Marriott, various South Dakota-based management companies that are linked to the Casper location, and James Koehler, who works for the management companies that bear his last name.

A Marriott spokeswoman directed comment to Koehler and the South Dakota companies. A message left for Koehler’s assistant was not returned Monday. An email to his company, the Koehler Organization, bounced back as undeliverable, and a third message sent via a form on the business’s website was not returned.

In the lawsuit, Pascarelli alleges that he was staying at the Courtyard Marriott in April 2012 when he woke up to discover “an enormous amount of painful, itchy, burning bites” on his buttocks and right leg. He had taken a shower the night before and had not noticed any such marks, the suit alleges.

Pascarelli eventually sought treatment at an urgent care clinic in Cheyenne, where he was working with a U.S. marshal. According to the lawsuit, he had “approximately 20” “nodules” on his upper legs and buttocks.

He went back to the clinic the next day because the marks were developing into pustules, indicating infection. The bites then grew into lesions, according to the lawsuit, and caused even more pain, while Pascarelli developed a fever.

Back in Atlanta, where the CDC is based, he was admitted to the hospital. Doctors confirmed that he had MRSA, a form of a staph infection that is dangerous because it is resistant to some antibiotics, as well as other issues related to the alleged bites.

The doctor said that the MRSA was “the result of the bed bug attack at (the) hotel during the early morning of April 9, 2012,” the suit alleges.

Pascarelli was a frequent patient of the hospital throughout April and underwent three surgeries to treat the infections. He incurred about $100,000 in debt, the suit alleges. He lost wages from his job at the CDC, the complaint continues, and is at risk of being forced to retire from the Air Force Reserve.

According to the lawsuit, he will need treatment for the MRSA for the rest of his life.

The suit does not list a specific dollar amount that it seeks, though it alleges Pascarelli could lose up to $500,000 in wages as a result of the infections.

“Defendants knew, and/or should have known, that the bed in (Pascarelli’s) hotel room at the (hotel) was infected with bed bugs,” the suit alleges, adding that the hotel and its owners “failed to take reasonable precautions, failed to implement reasonable safety inspections and/or failed to follow their own safety inspections to ensure that the (hotel) was free from insects and pests,” among other allege failures.

In a statement to the Star-Tribune, Pascarelli’s attorney, Jason Ochs, said that “bed buds have been known to be a major health issue in the hospitality industry for over a decade” and that the industry “has a duty to preemptively act in regards to this foreseeable problem in order to protect paying guests.”

CDC ALERT – DEADLY ‘KISSING BUG’ HAS INVADED NEW JERSEY

July 2, 2019 | by Matt Ryan | 943thepoint

The CDC is alerting New Jersey residents about the Triatomine bug, or ‘Kissing Bug.’ The way it infects is straight out of a horror movie.

CDC

The name ‘Kissing Bug’ came from the fact that this bug is known for biting people on the face. Guess I’ll never be sleeping again. This bug can infect animals as well. Once bitten, humans and animals run the risk of contracting Chagas.

Symptoms of Chagas include fever, fatigue, swelling, and a rash. It can, however, be deadly leading to stroke or heart failure. Chagas has even caused heart failure in dogs.

Don’t let the name fool you, this is no joking matter. ‘The Kissing Bug’ looks like this.

Steve Lenz

According to the CDC, these bugs can live indoors, in cracks and holes of housing, or in a variety of outdoor settings including the following:

  • Beneath porches
  • Between rocky structures
  • Under cement
  • In rock, wood, brush piles, or beneath bark
  • In rodent nests or animal burrows
  • In outdoor dog houses or kennels
  • In chicken coops or houses

So how do you keep these suckers out of your space? The CDC recommends:

  • Sealing cracks and gaps around windows, walls, roofs, and doors
  • Removing wood, brush, and rock piles near your house
  • Using screens on doors and windows and repairing any holes or tears
  • If possible, making sure yard lights are not close to your house (lights can attract the bugs)
  • Sealing holes and cracks leading to the attic, crawl spaces below the house, and to the outside
  • Having pets sleep indoors, especially at night
  • Keeping your house and any outdoor pet resting areas clean, in addition to periodically checking both areas for the presence of bugs

Consult a licensed exterminator when it comes to this bug.

S. Kjos via CDC

If you think that you’ve found a Triatomine bug, DO NOT TOUCH OR SQUASH IT! It’s a common reaction to kill a bug when you see one, but it’s not ideal with ‘The Kissing Bug.’

Instead, the CDC says to place a container on top of the bug, slide the bug inside, and fill it with rubbing alcohol or, if not available, freeze the bug in the container. Then, you may take it to your local extension service, health department, or a university laboratory for identification.

Surfaces that have come into contact with the bug should be cleaned with a solution made of 1 part bleach to 9 parts water (or 7 parts ethanol to 3 parts water).

If you think that you have been bitten, go to a healthcare provider immediately!

EWG Calls on CDC To Monitor US Population for Monsanto’s Weedkiller Glyphosate

FOR IMMEDIATE RELEASE:
WEDNESDAY, JUNE 26, 2019  by  Alex Formuzis

WASHINGTON – Glyphosate, the most heavily used pesticide in the U.S., should be added to the list of toxic chemicals the federal Centers for Disease Control and Prevention regularly measures in the bodies of the American people, Environmental Working Group said in a letter sent today to the CDC.

A growing body of research has found that Americans, including children, are exposed to glyphosate through food sprayed with the weedkiller, and from air and water because of the widespread presence of glyphosate in the environment.

A University of California biomonitoring study of more than 1,000 older adults in Southern California found that at least 70 percent had detectable traces of glyphosate in their bodies between 2014 and 2017. That compared to just 12 percent of participants tested between 1993 and 1996, EWG said in the letter to CDC.

The dramatic increase in exposure among the participants in the California study aligns with the growing amount of glyphosate – the active ingredient in Monsanto’s Roundup – sprayed on cropland since the mid-1990s. More than 250 million pounds were sprayed in 2016.

Most glyphosate used in agriculture is applied on Roundup-ready corn and on soybeans genetically engineered to withstand the herbicide. Increasingly, however, glyphosate is used on non-GMO wheat, barley, oats and beans. The herbicide kills the crop, drying it out so it can be harvested sooner. EWG has conducted three rounds of tests of popular oat-based cereals and snack foods marketed toward kids, and found glyphosate in nearly every sample of food.

recent review of 19 studies of the evidence of human exposure to glyphosate globally, led by researchers at the Icahn School of Medicine at Mount Sinai, highlighted the limitations of currently available data and concluded that additional studies are urgently needed.

In the letter, EWG urged the CDC to address the lack of nationwide biomonitoring studies of glyphosate, especially exposure of young children. “The EPA’s dietary risk assessments indicate that children one to two years old likely have the highest exposure levels, comparable with EPA estimates of exposure in occupational settings – and yet real-life data on infants’ and children’s exposure to glyphosate are missing,” EWG wrote.

Some of the most recent scientific research suggests that glyphosate exposure during pregnancy can harm the developing fetus as well as the health of newborns and young children.

In 2015, the World Health Organization’s International Agency for Research on Cancer classified glyphosate as “probably carcinogenic” to people. In 2017, the herbicide was listed by the California Office of Environmental Health Hazard Assessment as a chemical known to the state to cause cancer.

“A national biomonitoring effort will give epidemiologists the opportunity to study the health effects associated with glyphosate exposure,” wrote Olga Naidenko, Ph.D., vice president for science investigations at EWG, and Alexis Temkin, Ph.D., an EWG toxicologist.

EWG###

DEADLY ‘KISSING BUG’ HAS INVADED INDIANA

Deadly_Kissing_Bug.PNGThe Center for Disease Control and Protection is warning residents in the United States about a deadly bug that has made its way to 12 different states including Indiana. An insect know as a Triatominae, has been known to bite people in the face and infecting them with disease called Chagas. This disease has been dubbed as the deadly “Kissing Bug.”

These insects are not something to mess around with. Some of the symptoms of Chagas are fever, fatigue, swelling and a rash but it can be more serious causing strokes or even heart failure. Your pets aren’t even safe from the triatomine insects, as Chagas can actually give your pets heart disease.

I found what looked like a Triatominae in my house the other day. I can’t say for sure if it was, but it certainly looked like one. These bugs, when found inside your home, are typically located near the places your pets sleep, in areas of rodent infestation, and in/around beds and bedrooms (especially under or near mattresses or night stands.

The one I found was on my night stand. I didn’t take my chances, so I squished it…which apparently you aren’t supposed to do if you find one. According to the CDC:

If you find a bug you suspect is a triatomine, do not touch or squash it. Place a container on top of the bug, slide the bug inside, and fill it with rubbing alcohol or, if not available, freeze the bug in the container. Then, you may take it to your local extension service, health department, or a university laboratory for identification.

Surfaces that have come into contact with the bug should be cleaned with a solution made of 1 part bleach to 9 parts water (or 7 parts ethanol to 3 parts water).

If you want to take precautions to keep the triatomine bug out of  your house, the CDC recommends that you contact a licensed pest control operator before you use any insecticides to kill triatomine bugs. It should also be noted that roach hotels or other “bait” formulations do not work against these bugs. Other precautions to prevent house infestation recommended by the CDC include:

  • Sealing cracks and gaps around windows, walls, roofs, and doors
  • Removing wood, brush, and rock piles near your house
  • Using screens on doors and windows and repairing any holes or tears
  • If possible, making sure yard lights are not close to your house (lights can attract the bugs)
  • Sealing holes and cracks leading to the attic, crawl spaces below the house, and to the outside
  • Having pets sleep indoors, especially at night
  • Keeping your house and any outdoor pet resting areas clean, in addition to periodically checking both areas for the presence of bugs

(Source: CDC- Triatomine Bugs)

Suspected Bed Bug Spotted at Crosby High School in Waterbury

CROSBY+HIGH+SCHOOL

logo_ct_2xMay 22, 2019

A suspected bed bug was found at Crosby High School recently, according to a letter from the principal.

According to a letter from Principal Jade L. Gopie, school staff contacted the City Health Department and School Facilities Division to begin a cleaning of the impacted areas once the suspected bed bug was found.

Bed bugs are common in the U.S. and do not pose any immediate health risk to humans, according to the CDC. Though not considered dangerous, a bed bug bite could cause an allergic reaction and any bites should be looked over by a doctor.

“Virtually all instances of beg bugs in a school environment are the result of the insect being carried in from the outside in isolated circumstances. The Waterbury Board of Education and the City Health Department consider the health and safety of students and our school community as a top priority. We will continue to work collaboratively and proactively to maintain the schools as insect free and to support the remediation of issues outside of the school environment,” Gopie wrote in the letter.

Gopie said all the impacted areas were cleaned and there will be follow-up inspections as needed.

There have also been recent reports of bed bugs at Waterbury Career Academy High School. School officials have said these are isolated incidents.

Starbucks accused of exposing New York City customers to toxic pesticide

NBC

One of two lawsuits filed against the coffee company states that Starbucks stores “have for many years been permeated with a toxic pesticide.”

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A sign hangs in the window of a Starbucks store on May 29, 2018 in Chicago.                                           Scott Olson / Getty Images

May 21, 2019, 3:32 PM EDT
By Minyvonne Burke
Two lawsuits filed against Starbucks claim that several New York City stores exposed customers to a poisonous — and potentially deadly — pesticide toxin, and then fired a store manager who complained about them.

In one class action suit, filed on Tuesday in state court in Manhattan, 10 Starbucks customers claim that they were “exposed to the toxic chemical” Dichlorvos, or DDVP, after making purchases in multiple city stores over the last three years.

DDVP is an ingredient that is emitted into the air by a pesticide called Hot Shot No-Pest Strips, which are produced by Spectrum Brand Holdings.

The lawsuit states that Starbucks uses the strips in its Manhattan stores to keep cockroaches and other pests away. The strips, which can be purchased in many home and garden stores as well as online, kill insects but are also harmful to human beings, according to the lawsuit.

Spectrum Brand Holdings did not immediately return NBC News’ request for comment.

Photos accompanying the lawsuit show the strips next to bagels and food preparation equipment and near air vents.

“Starbucks stores throughout Manhattan have for many years been permeated with a toxic pesticide called Dichlorvos, which is highly poisonous and completely unfit for use in proximity to food, beverages and people,” the suit says.

The lawsuit states that the Center for Disease Control and Prevention says pesticides containing DDVP should only be used in enclosed spaces where people are either not present or are given a respirator or other breathing apparatus.

According to the Hot Shot website, the strips should not be used “in kitchens, restaurants or areas where food is prepared or served.”
Exposure to DDVP can result in symptoms which include loss of bladder control, muscle tremors and weakness, trouble breathing, nausea and paralysis, the lawsuit states. Severe exposure can result in coma and death.

“On numerous occasions over the last several years, Starbucks’ employees and third-party exterminators have informed regional and district management – both verbally and in writing – about the improper and dangerous use of No-Pest Strips throughout stores in Manhattan,” according to the lawsuit.

“Needless to say, Starbucks has closely held this information and has not disclosed to the public that DDVP has poisoned the environment in its stores.”

The suit alleges that the customers, who are from New York, South Carolina and California, experienced emotional distress and anxiety “that they would develop serious health issues.” They are seeking an unspecified amount of damages.

In the second suit, also filed Tuesday in Manhattan’s federal court, a former Starbucks employee claims he was abruptly fired in February 2018 after complaining about the misuse of the pesticide strips.

A pest control technician who worked at multiple Manhattan Starbucks locations, and his supervisor, also allege that from 2016 to 2018 they made several complaints about the strips. In June 2018, Starbucks terminated its contract with the pest control company to silence the technician’s “repeated reports and complaints about the foregoing risks to health and safety,” according to the suit.

The former employee, technician and supervisor are seeking unspecified damages.

A spokesperson for Starbucks said Tuesday that the pesticide strips were being used in violation of its policy and once it was made aware of the complaints, the company stopped using them. The spokesperson also said they hired an outside expert who determined that Starbucks’ customers and employees were not put at risk.

‘Kissing Bug’ Disease, Chikungunya, and Dengue Arrive in US Amid Rising Temperatures

Healthline
Faraway tropical countries no longer have the market cornered on painful bug-borne illnesses.

'Kissing Bug' Disease, Chikungunya, and Dengue Arrive in US

Chagas, dengue, and chikungunya are likely to become more familiar words in the United States in coming decades. Once limited to climates more tropical than our own, these infectious diseases are now increasingly affecting Americans.

There have always been a handful of Americans who return from tropical travel infected with these diseases. But experts think it’s likely that they will take root here.

As the climate continues to warm, the insects that spread these diseases from one person’s bloodstream to another’s will inhabit larger swaths of the map, according to the United Nations International Panel on Climate Change (IPCC). The habitats of the mosquitoes that carry dengue and chikungunya are already expanding in the United States.

“Climate change is definitely having an effect on parasitic disease worldwide,” said Patricia Dorn, Ph.D., a Chagas expert at Loyola University New Orleans. But, she said, we’re also getting better at testing for these diseases, so part of what looks like an uptick in cases is really an uptick in diagnoses.

For patients, the difference is academic: They’re being diagnosed with diseases they may have never heard of — and their doctors may not know to look for them.

Chagas Disease: It’s Not Just in Rural Areas

Chagas is the latest addition to the list of tropical diseases that Americans have to fear. The disease initially has few symptoms — possibly a fever, rarely some swelling at the site of the bug bite — but if left untreated the parasites accumulate in the cardiovascular system and cause heart damage in 1 in 3 patients.

Triatomine, or “kissing,” bugs spread Chagas disease — though their nickname puts an overly positive spin on what they do: suck the blood of a mammal host and then defecate. The feces spread the parasite that causes the disease.

Chagas is widespread in Latin America and has rarely been considered endemic to the United States, but experts say that’s because we weren’t looking for it.

In 2007, Chagas was added to the list of tests performed on donated blood. Those who tested positive were contacted and interviewed. It suddenly it became clear that at least a few of the 300,000 Americans who tested positive for Chagas disease had not traveled to Latin America.

Triatomine

Bugs in the triatomine family capable of spreading the disease inhabit the bottom two-thirds of the United States. The now-outdated conventional wisdom said that the bugs, which bite at night, only fed only on humans living in thatched huts in rural areas.

“The dogma for years was, ‘We live in improved housing; we have air conditioning — yeah, the bugs are here but they live in wooded areas and we’re just not in contact with them.’ Our most recent study shows that that dogma is wrong,” Dorn said.

A forthcoming study co-authored by Dorn documents that triatomine bugs in Louisiana often feed on human blood. Among the bugs that had fed on humans, 4 in 10 tested positive for the Chagas parasite.

A Texas study published in October used blood donation data to identify five people who had been infected with the virus in Texas.

As the climate continues to warm, triatomine bugs will likely push further northward. And as forested lands are cleared, the bugs are likely to feed more often on humans.

Just this week, a study suggested that bedbugs could spread the parasite, too. But Dorn and Melissa Nolan Garcia, M.P.H., who co-authored the Texas study, said those findings don’t mean much on the practical level.

Although bedbugs are seemingly capable of transmitting the parasite, they probably don’t, based on empirical data. Among different triatomine species, some are far more efficient at transmitting the Chagas parasite, and even the most efficient do so only once in a thousand bites.

“We think that our bugs have better manners,” said Dorn, referring to U.S. triatomine bugs. “In Latin America the better vector takes a blood meal and defecates at the same time. The studies that we did showed that the bug took the blood meal — it was from a mouse — and left the host and defecated later.”

What does all this mean for patients? It means that those who hunt and camp in the South and those who have traveled to Latin America should get screened for Chagas.

“It’s a simple blood test,” Nolan Garcia said.

However, U.S. doctors don’t necessarily know what to do about Chagas. Dorn told the story of a California woman who got a “really scary letter” telling her that she’d been permanently banned from blood donation after testing positive for Chagas. But when she went to her doctor, he didn’t know how to treat her.

The only two drugs to treat Chagas disease are available through the Centers for Disease Control, which has dubbed Chagas a “neglected parasitic infection” and targeted it for public health action.

Nolan Garcia compared treatment with these drugs to “chemotherapy.”

The parasites settle in the heart tissue, and to eliminate them, the drugs have to kill off some healthy tissue too. The treatment is recommended for patients younger than 50 and on a case-by-case basis for those older than 50.

Dengue Fever: It’s Creeping up from Latin America

Dengue is a mosquito-borne viral infection so painful that it’s also called “breakbone fever.” Found throughout the world in tropical and subtropical regions, it’s rarely fatal. Those infected a second time with a different strain of the virus risk developing a more severe form of the disease called dengue hemorrhagic fever; without good medical care, 1 in 5 patients die from this form of the disease.

Dengue has become more common since the 1950s. In the Americas, it’s become at least five times more prevalent since the 1980s. But only in this century has it crept into the United States. Hawaii saw a cluster of infection in the early 2000s, but in recent years Texas and Florida have been U.S. hotspots.

Last year, there were 49 confirmed cases of locally transmitted dengue in the United States. So far this year, all of the hundreds of reported dengue cases along the U.S.-Mexico border have come in from Latin America, Texas public officials told Healthline. However, Florida has confirmed six local cases.

Some counties in Mississippi may also be at “extreme risk” for domestic transmission, experts say.

The mosquitos that carry the dengue virus, Aedes aegypti and Ae. albopictus, are expanding their range, in part due to climate change. As they do, more Americans will be at risk.

I do think it’s a real possibility that we could have sustained transmission [of dengue] in parts of the U.S., in the southern U.S. in particular, and in parts with lower socio-economic status.
Crystal Boddie, UPMC Center for Health Security

“I do think it’s a real possibility that we could have sustained transmission in parts of the U.S., in the southern U.S. in particular, and in parts with lower socio-economic status,” said Crystal Boddie, M.P.H., at the Center for Health Security at the University of Pittsburgh Medical Center in Baltimore.

Window screens, air conditioning, and an indoor job all diminish one’s risk of infection.

The United States won’t be hit as hard as developing countries, where screens are rare and air-conditioning is a luxury reserved for the very rich. But as dengue becomes more common, U.S. doctors will have to learn to diagnose it and provide the right kind of palliative care.

“The initial symptoms are pretty similar to the flu. It’s hard to distinguish if it’s dengue or flu,” Boddie said. “It’s difficult to diagnose if you’re not looking for it specifically.”

The good news is that, because dengue is so widespread in other parts of the world, researchers have been trying to develop a vaccine. Five candidates are currently being tested in advanced clinical trials.

Chikungunya

Chikungunya has symptoms similar to dengue and is spread by the same two types of mosquito. The two diseases often arise in the same places, but more people get sick from chikungunya because infected mosquitos are about three times as likely to transmit it.

Standing water

The disease is less likely to be fatal than dengue, but it’s painful enough to have earned its own colorful name. Chikungunya m­eans, roughly, “writhing disease” in a local language of East Africa, where it first emerged.

“It’s not a trivial disease,” said Roger Nasci, Ph.D., the chief of the Arboviral Diseases Branch at the CDC. He described “prolonged, debilitating joint pain where people just can’t get out of bed.”

About 1 in 3 chinkungunya patients will experience joint pain for months or even years after they recover from the initial infection. There are currently no medications to treat chikungunya and there is no vaccine to prevent it.

Until chikungunya entered India in 2005 and infected 2 million people, it wasn’t on the global health community’s radar. Last year, it earned still more attention when it jumped the Atlantic, sickening people on several Caribbean islands. This year, there have been 11 cases of locally transmitted chikungunya in Florida.

Public health officials say more domestic infections are “inevitable.”

The CDC is trying to educate doctors to make them aware of chikungunya and dengue. Beginning in 2010, doctors were required to report cases of dengue. On Jan. 1, 2015, they’ll be obligated to report chikungunya cases as well.

Mosquitoes breed in pools of standing water, so removing these breeding sites is a top priority. Nasci said the CDC is working with local mosquito control programs to try to limit the number of tires, buckets, and other outdoor sites that collect rainwater. In that one respect, climate change may actually help curb mosquito populations, as California and other Western states experience record droughts.

Healthline News | Cameron Scott | November 20, 2014

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