Sunday, May 31, 2009

‘Underlying Conditions’ May Add to Flu Worries

‘Underlying Conditions’ May Add to Flu Worries

"Underlying conditions" have been held responsible for many severe cases of swine flu in New York City. These conditions include diabetes, asthma, heart disease, lung disease, weakened immune systems, obesity and other conditions that aggravate symptoms. The term has been used to cover all manner of things since swine flu has become a presence in New York.

Originally used to reassure people who did not have any of these "underlying conditions," the term could potentially scare much of the population, as the conditions are fairly widespread. About 50 percent of swine flu hospitalizations globally and about 70 percent of those in the United States seem to involve underlying conditions.

Elaine Su

Parasites: Giving a Deworming Drug to Girls Could Cut H.I.V. Transmission in Africa

Parasites: Giving a Deworming Drug to Girls Could Cut H.I.V. Transmission in Africa

Researchers think that administering a deworming drug, praziquantel, to girls in rural Africa could reduce transmission of HIV. The drug costs 32 cents a child and prevents a worm disease, schistosomiasis, that starts as a urinary tract infection. Left untreated, the UTI can lead to female genital sores that make HIV transmission easier. Girls should be protected before they reach sexual maturity, because the drug will not cure sores once they form.

90 percent of cases of schistosomiasis occur in Africa, where people get it from wading into snail-infested water to swim or wash clothes. The first symptom is bloody urine.

A pilot program suggests that children and young adults in Africa can be treated for $22 million; repeating that every two years for a decade would cost $112 million.

Elaine Su

Schistosomiasis treatment to prevent HIV?

A study published in PLoS Neglected Tropical Diseases and mentioned in the New York Times has gathered together evidence indicating that treatment for schistosomiasis, a parasitic blood trematode (worm) infection, may be a good way to prevent HIV.

The vast majority (over 90%) of the schistosomiasis disease burden is in Africa. Apart from any association with HIV, it is a damaging disease—it can lead to severe disability by causing anemia and chronic inflammation. S. haematobium, one of the three main species of the parasite infecting humans, is responsible for about 2/3 of cases in Africa and causes urinary tract infections that can lead to bladder cancer.

Now, multiple studies indicate that s. haematobium also causes Female Genital schistosomiasis (FGS). This happens when parasite eggs are deposited in a woman’s genital tract, causing lesions that look similar to an STI. They are associated with “contact bleeding” (during sex or a pelvic exam).

STI lesions facilitate HIV transmission by providing more unprotected surfaces for the virus to enter, and researchers hypothesize that FGS lesions work in exactly the same way.

It appears that only one actual study has been done so far to test this hypothesis, among rural Zimbabwean women. It found that women with FGS had a 3-fold higher risk of having HIV relative to women without FGS. However, the study was cross-sectional, making causation less clear. The authors of the Zimbabwean study called for a prospective study confirming their results.

Although no other studies have confirmed the FGS-HIV association, they have contributed to the evidence in its favor. Another Zimbabwean study, for example, reported that women who received early treatment for schistosomiasis had fewer lesions that would presumably contribute to HIV transmission.

The authors of the PLoS article, although they concede that more research must be done, also argue that the evidence we have mandates immediate implementation of treatment programs—particularly because Praziquantel, the treatment for schistosomiasis, is incredibly cheap and effective. They argue that it would be a comparatively minimal addition to PEPFAR’s budget, and could significantly prevent HIV transmission in the approximately 19 million girls at risk for developing FGS in sub-saharan Africa in the coming decade.

Older women who already have FGS lesions may not benefit very much from Praziquantel (it doesn’t usually reverse existing lesions). Therefore, The authors believe that Praziquantel should be administered early, ideally among school-age girls in areas where HIV and schisto overlap, such as Malawi, Moxambique, and Tanzania, and Zimbabwe.


Book Review: Demon in the Freezer

Lawrence Brilliant hadn’t been studying long with Neem Karoli Baba before the guru began hitting him with apples during meditation sessions.

It was the summer of 1970 and Larry, a recent medical school graduate, had traveled overland with his wife and his friend "Wavy Gravy" in a “rotten old British Leyland bus they bought cheap in London. They painted it psychedelic colors and filled the bus with medicine and food and a bunch of hippie friends," hoping hoped to make it to Bhola in southwestern Bangladesh, which had been hard-hit by a recent cyclone.

But civil war on the border led them instead to an Ashram at the foot of the Himalayas, where an unexpectedly forceful guru had an unusual message for his new pupil.

“You are going to eradicate smallpox,” said Neem Karoli Baba to Larry. “Go to New Delhi. Go to the office of the World Health Organization. Go get your job.”

As Larry, then short, bearded, and ponytailed, recalls: “…there was this tall guy sitting in the lobby of the WHO office. He looked up and said, ‘Who are you? What are you doing here?’"

“I’ve come to work for the smallpox program.”

“There isn’t much of a program here.”

“My guru says it will be eradicated. Who are you?”

“I’m DA Henderson. I’m the head of the program.”

Richard Preston’s Demon in the Freezer is full of encounters like this one. Although his writing is very much based in fact—he performs background research and conducts extensive interviews with his subjects—“What makes these scenes powerful,” as Preston explains on his website, “is that the people are verifiably real and the universe is the actual one we live in, not the universe of a novelist's imagination. Thus the scenes have a versimilitude that can exceed that of the novel, and can take us into the heart of human experience.”

Preston’s dramatic approach to nonfiction may prove gripping or infuriating, depending on what you’re into. Demon reads like a thriller novel, sweeping readers through a meandering array of infectious disease topics centering on the story of smallpox eradication and the debate over the fate of its remaining stocks.

Preston’s writing style goes a bit over the top at points, as in his discussion of smallpox containment:

“The smallpox at the CDC’s repository may be kept in mirrored form…[but] people at the CDC do not discuss the details of the storage, and many of them may not know of the existence of the vault. They don’t know, and they don’t ask.”

If Preston, a journalist, can write about "the vault" in a widely-acclaimed book, clearly the CDC’s employees might know something about it. But such claims are in the service of a good story, and, overall, Preston does a fantastic job of using his style to make the facts of smallpox come to life.

The drama is best justified when, as with Brilliant’s story, Preston focuses on individuals. One of the best characters in Demon is Lisa Hensley, an Ebola researcher with USAMRIID, the US Army’s Medical Research Institute of Infectious Diseases. We follow her through a large part of the book, first to an Ebola lab, and later to the CDC, where she is commissioned to perform smallpox experiments on monkeys. We learn about Lisa’s childhood and family—her father, who “took her into his laboratory and taught her to grow bacteria on petri dishes”—her romantic life, and her professional doubts.

Preston’s descriptions of Lisa’s first experiences working in a “space suit” give a fantastic sense of what the nearly-deadly, yet oddly peaceful, world of Level 4 containment might be like. Later, we witness a terrifying scene in which Hensley pricks a glove with scissors in the Level 4 Lab, and is potentially exposed to Ebola.

“Hensley felt a sudden rise of fear, which turned into a little bit of panic. What was the last thing I had touched with my hand? What was I doing? What were the scissors touching? Was there any [Ebola] on the scissors? The mind goes sticky in a moment of fear. She blanked. She couldn’t remember what she had been doing with her hands. There was nobody to ask.”

The scene itself is gripping enough—but it was the connection I already felt with Lisa, from learning about her family and her story, that made me genuinely scared while reading.

Preston’s literary liberties do seem to come at the expense of a few facts. These are mainly one-word inaccuracies, as when he calls "primates" the “closest relatives of humans” and makes statements like “when a person dies of AIDS…”. I don’t think that the degree or number of those slip-ups, however, detracts in any significant way from the purpose of the book.

Occasionally, in the service of his style, Preston also makes statements that should perhaps be phrased as opinion; for example, “In order to develop drugs and a new vaccine for smallpox, it would be necessary to do experiments with live Variola.” These seem more serious than the factual slip-ups. But again, when considered in light of the vast amount of information Preston is able to convey in such an accessible manner, the number of inaccuracies seems negligible.

Preston accomplishes something incredibly rare in science writing: he writes, to put it bluntly, very well. This is no small accomplishment. It is hard to get the public past a Hollywood-level interest in infectious disease, and into the nuts and bolts of research or smallpox containment, largely because there is no middle ground between Hollywood thriller and ultra-dense scientific papers.

Preston provides that middle ground. At one point, by going to a lab himself and describing his experiences working with a technician, Preston makes a gripping chapter out of the subject of mousepox virus modification. The equivalent information in an infectious disease journal wouldn't be touched by a non-researcher.

For his ability to bring such information to the public in Demon and in his other books, Preston has been recognized by the scientific community: he is the only non-medical doctor to receive the CDC’s “Champion of Prevention Award” for public health.

It is well-deserved. If you can accept Demon for the unique "educational thriller" that it is, it has quite a lot to offer. It does a memorable, entertaining, and educated job of capturing the stories and debate surrounding smallpox eradication and containment.


Friday, May 29, 2009

Why we love smallpox?

In this week’s New York Times, Dr. Abigail Zuger reviews two books dealing with what she calls the “insatiable fascination with contagious illness” that is “hard-wired into all of us.”

The first—"Dread," by epidemiologist Philip Alcabes—argues that epidemics are intriguing because they “hit us right at the nexus of self-interest and altruism, that exquisitely uncomfortable spot where our brother’s misfortune nudges us just enough that we need to examine it and distance ourselves from it.”

"Dread" reviews the history of human attitudes towards epidemics. In particular, it appears to argue we’ve undergone a collective shift from an individual to a more public health mentality towards illness: rather than focusing on distancing and protecting ourselves, we now also reach “through the wall and [protect] the well by treating the ill.”

Alcabes discusses the use of the word “epidemic” to inspire public reaction, as in the case of the “obesity epidemic” in the United States today.

The second book—"The Lassa Ward" by Dr. Ross Donaldson, recounts personal experiences as a medical student in Sierra Leone. It focuses on the atmosphere at the center of epidemics; particularly, at how that environment can be “strangely orderly," and at the “bizarre stubbornness that often permeates stricken communities and prevents the very changes that might save lives.”

Although "Dread" does appear to focus on the reasons for our fascination with disease, it is, according to Zuger, written “with the trademark mumble of the social scientist.” "The Lassa Ward" sounds like a better read, but, aside from Dr. Donaldson’s personal fascination with epidemics, doesn’t seem to deal directly with the question of our contagion fascination.

As someone who shares that fascination, it’s certainly a question I’ve wondered about. Zuger suggests it is something "hard-wired"; I’m sure evolutionary psychologists could offer a wealth of explanations for our interest. Maybe fascination with disease is related directly to self-preservation (it makes us more aware of what can kill us?), or maybe it evolved as a byproduct of some more useful evolutionary trait. Maybe, on the other hand, we’re fascinated because of the media, our current culture, or our increasingly globalized world that spreads disease faster and more broadly than ever before. Or, maybe we're not, actually, that fascinated--at least, not any more so than we are by horror films or romance novels.

A 2007 JAMA article by Howard Markel looks at the poplarity of epidemic literature skeptically. “Every year,” writes Markel, “a teeming petri dish of popular and occasionally bestselling contagious narratives appear on bookstore shelves.” These, Markel argues, are significant because they have the power to shape how the public thinks about public health, which leads to an influence on public policy. He also worries that people have a “dangerous propensity to forget about [epidemics’] remarkably destructive powers once they subside,” thus losing the memory of something that could provide important lessons for the future.

Markel’s concerns seem overblown—sensationalist literature doesn’t, to me, appear to have much of an influence on health policy. But, I think that he—as well as the two authors reviewed by the Times—are right to believe that thinking about public attitudes towards epidemics (whether fascination, fear, or indifference) is incredibly important. In the same way that understanding different cultural beliefs about smallpox ended up being key to its eradication, so understanding cultural attitudes towards all types of critical infectious diseases, like HIV/AIDS and Malaria, is key to successfully tackling them from a public health perspective. Understanding those attitudes is what the whole field of medical anthropology is about!

And it’ll be a bonus if, in the process, we can figure out why at least some of us are so oddly obsessed with all things infectious.


Thursday, May 28, 2009

Vaccine-autism controversy alive and well

PLoS Biology has released a unfunded report consulting various experts on why the vaccine-autism theory persists despite scientists' and public health officials' best efforts to provide evidence to the contrary. 1 in 4 Americans still think vaccines stil cause autism, and vaccination rates have dropped overall, which puts people at risk for formerly eliminated diseases like measles. In Britain MMR vaccination rates lowered from 92% in 1998 to 80% by 2003. Spokespeople for scientists reporting the results of digressing studies receive death threats.

Anthropologist Sharon Kaufman believes that the persistence of the belief stems from the legislative action that revealed new information regarding the contetns of vaccines. This change in the perception of scientific fact was able to feed the speculative theories tracing vaccines to autism. Baker, the director of the program in the History of Medicine at Duke University, believes that parents also think that environmental factors are behind rising rates of autism, and that vaccines are the most obvious candidate.

Yet there also seems to be an important, media-induced tendency to view the vaccine-autism controversy as a debate, playing up misinformation that dilutes the public's trust in experts and setting up an "us versus them" scenario. Pediatrician Paul Offit summed it up best. When talking about his refusal to go on Larry King Live or any show that hosted celebrity anti-vaccine advocates like Jenny McCarthy, he said "McCarthy is the hero, her child is the victim--and that leaves one role for you."

Clearly the controversy has grown beyond the reach of scientists. It seems that, given the media-stoked debate and parental misconceptions, scientists may not be the best vessels to promote the crucial evidence in the vaccine-autism controversy. Perhaps what the issue needs is another well-known individual that can create a countering emotional appeal, one that can successfully challenge the prominent activists on the anti-vaccine side of the issue.

-Andrew Plan

article link:
PLoS report link:

Wednesday, May 27, 2009

New and hot: Transgenic monkeys

Scientists in Japan have infused transgenic monkeys with a gene to make their feet glow green under UV light, and one of these marmosets has successfully passed the gene on to its offspring. The transgenic monkeys were created by inserting the genes into viruses and injecting them into embryos. This is a difficult process, so the successful passing along to offspring would mean the ability to more easily mass-produce transgenic animals.

Aside from the coolness of passing along a gene that makes feet glow green, this has huge implications for the development of animal models for the study of human conditions, including infectious diseases, immunological diseases, and neurological diseases.

This success should be tempered by the memories of similar attempts that have failed, though, like one last year for Huntington's disease. Nevertheless, this shows promise, and will no doubt stir up debate.

Here are a couple of the articles I read, but others should be easy to find:

-Andrew Beck

Tuesday, May 26, 2009

Buckyballs as potential inhibitors of HIV

A group of researchers from around the world (Rice University in Texas, Italy, Germany, and Greece) have collaborated to generate more than 100 computer simulations of buckyball derivatives that could be used to bind to the active site of HIV-1 protease and thus disable the enzyme. As we previously discussed in class, a buckyball is carbon fullerene or C60. HIV-1 protease is the enzyme responsible for cleaving the polyproteins at specific sites to create the smaller protein components of an infectious HIV virus. Without the protease, the virus remains uninfectious because it cannot replicate and infect additional cells. It has long been known that C60 fits into hydrophobic pocket in HIV and thus has an inhibition effect. The effect, however, was not particularly strong because it was not the perfect unit. This newly developed computer simulation allows various modifications of C60 to find that perfect unit.

Like we discussed in class today, vaccine and drug development has traditionally been of the trial and error method. However, this kind of research is a shift from the paradigm to a more rational and "educated" way of approaching drug development. I think this kind of research also highlights the need for people of all backgrounds and occupations in any public health intervention. While people do not traditionally associate computer science or math majors with public health, there is a serious need for people with these backgrounds in order to fight diseases such as HIV in a "smart" and effective way. You don't have to be a doctor or a public health major to make an impact in the fight against HIV.

To read the full article:


PS. Try to see if you can spot the pentagons in the buckyball!

New and Hot: HPV Vaccination in Men?

Merck, the maker of the HPV vaccine Gardisil, is pushing for vaccination of young men. In December Merck asked the FDA to approve the vaccine for males ages 9 to 26, and last February the company presented the results of a male vaccination study to the CDC's Advisory Committee on Immunization Practices in the hopes that the CDC will endorse male vaccination in June. The study tested the vaccine in 4,000 men ages 16-23, and according to Merck, shows that the vaccine is about 90% effective in preventing infection from four types of HPV.

According to the CDC's HPV vaccine work group, the issue is cost-effectiveness. In women, the vaccine helps prevent cervical cancer, which threatens 10,000 Americans a year. For men, the vaccine would help prevent rarer diseases: penile and anal cancer. Because there is less of a direct benefit for males, at least part of the motivation for vaccination would have to be altruistic—vaccinating males could help prevent the spread of the virus to their sexual partners. As such, individual male patients might be unmotivated to shell out $300 for a vaccine that doesn't provide direct benefit.

It will be difficult to make a thorough cost-benefit analysis, as the prevalence of HPV infection in men is fairly uncertain. A literature review in The Journal of Infectious Diseases showed that various studies found a range of HPV prevalence between 1.3% and 72.9% (depending on kind of test, DNA and antibodies, and which part of the body samples were taken from). The chart below shows prevalence of HPV in men of various populations. It seems as if this range is so broad that it is practically useless. Furthermore, little is known about the rate of transmission.

-Elaine C

Journal of Natl Cancer Institute News Article
Washington Post Article
Literature Review

ST-246 and eczema vaccinatum

A follow-up to our discussion today in class, and to Cooper’s post, “Smallpox vaccine and Eczema,” below!

A 2-year-old boy in the US came down with eczema vaccinatum, a life-threatening reaction to live vaccinia virus, in March 2007. Reactions to vaccinia (as we’ve learned) are usually not serious, but can become so in immunocompromised patients or, as in this case, in patients with eczema. Symptoms of eczema vaccinatum are very similar to smallpox (see picture).

After he was diagnosed (doctors had to rule out herpes and chickenpox, and conduct PCR tests to confirm presence of a poxvirus), the boy was injected with vaccinia immune globulin. When his condition worsened, they added cidofovir —which is actually licensed to treat cytomegalovirus, but can be used in emergencies for vaccinia complications. Cidofovir didn’t seem to work, either. Because the boy’s condition was life-threatening and growing worse, doctors decided to try ST-246, a new, experimental drug—and the boy slowly started to improve. ST-246, as we discussed in class, is an orally active drug inhibiting viral replication for multiple poxviruses.

It’s unclear what actually saved the boy, since he was receiving three different drugs and a variety of other care. The article says that blood samples weren’t able to pinpoint the exact time at which the boy’s viral levels dropped. But, it appears that ST-246 may have been a significant part of his recovery, and deserves further research.

The case raises a lot of questions about current smallpox vaccination policies. The boy was exposed to vaccinia through his father, a soldier stationed in Iraq, who had received the smallpox vaccine. Although public vaccination ended after 1979 and military vaccination after 1990, Bush re-started military vaccination in 2002. Whether or not the benefits of military vaccination outweigh the risks is a continuing subject of debate. And technically, this soldier (at least) should have been screened out of vaccination because of his son’s condition.

Although doctors and public health agencies worked well together to save the boy, the overall handling of the situation doesn’t bode well for a real smallpox epidemic: if it had been smallpox, say experts, the slow speed at which the health system rallied to action means that many more people would have been infected and killed.

Here's the Science mag article,


Millennium Development Goals Report

The WHO compiled a midway report on Millennium Development Goals and found mixed results. For example, one of the goals is to drop the child mortality rate by 2/3 by 2015. When comparing deaths of children under 5 years old in 1990( the baseline year) with now, we see a 27% drop in the death rate. However, the drop in the death rate in African countries is lagging behind what it should be to reach the goal of 2/3 by 2015. The MDGs were created by the UN to help push health care in developing countries, and have been met with some success. However, prenatal and newborn care have not improved significantly and still account for many of the deaths recorded by WHO.

Katie Ridley

Monday, May 25, 2009

Egyptian Government Uses Swine Flu as Excuse to Get Rid of Pigs

-C. Paula de los Angeles

For the zabaleen of Egypt, garbage collecting is a way of life. Women sort it, children collect it and play in it, trash is a commodity. Even pigs, who co-inhabit the same neighborhoods as the zabaleen, eat the separated rotten food from it. A grandson of the original zabaleen expresses, "It's not a job, it is a life". But this may soon have to change.

In an extreme reaction to the fears of swine flu epidemic spreading around the world, Egypt decided to kill all its pigs (~300,00), even though there have not been any cases within the country yet. Despite international outcry to halt the procedures because of its inhumanity and lack of justification (the pigs are not spreading the disease), the Egyptian government has refused to stop. The pigs do not even receive a quiet death, but a violent one consisting of stabbing and metals rods.

Shockingly, the government has admitted that the mass massacre of the pigs is not just to prevent the spread of swine flu, but to clean up the lives of the zabaleen.

Many important cultural questions need to be asked, especially with respect to forcing one culture's ideas on another. The country's majority Muslim population appears to be a motivating force to get rid of the pigs, against the will of the zabaleen, who tend to be Chrstian. Furthermore, the government insists on "cleaning up" the zabaleen, placing judgment on their way of living. Finally, what is the danger of using incorrect scientific data to justify government policy?

Very interesting and sad dilemma.

NY times article here:

Smallpox Vaccine and Eczema

This news story requires a bit of background: First, a number of groups of people cannot be given the smallpox vaccine because they have compromised immune systems; these include patients with AIDS and patients undergoing chemotherapy. In addition, patients with eczema cannot have the vaccine; a 2007 article in Science recounted the case of a two-year-old boy with eczema who acquired exzema vaccinatum, a potentially fatal disease, from his recently-vaccinated father (a member of the military). Eczema vaccinatum, although unusual today because so few people receive the vaccine, was a side effect often seen in children through the 1960s. Today, researchers are trying to design vaccines that are safer for these vulnerable populations. To do so, they must understand the exact mechanism by which immuno-compromised people and eczema sufferers react to vaccinia (

A study published today by researchers at La Jolla Institute for Allergy & Immunology identifies what appears the underlying cause of the severe reaction of people with eczema to the smallpox vaccine. The research was conducted in mouse models with eczema by a husband/wife research team, Toshiaki and Yuko Kawakami. The researchers administered the smallpox vaccine to mice with eczema and found that IL-17 cell levels were higher in mice who developed eczema vaccinatum than in normal mice. IL-17 cells inhibit Natural Killer cell (NK) activity; NKs are cells of the immune system that fight disease. Because of this inhibition, NKs were slower in responding to vaccinia in mice who developed eczema vaccinatum than in normal mice. The researchers tested this theory by stimulating increased NK cell activity in mice with eczema, and they found that the higher activity eliminated eczema vaccinatum.

Eczema, the common name for atopic dermatitis, affects 17% of children in the US. Eczema vaccinatum has a fatality rate of 5-10%, so these children, as well as the people they live with, cannot receive the smallpox vaccine. They are vulnerable should smallpox ever reemerge in the world by accident or through biological warfare. The new knowledge from this study may allow researchers to develop therapies to boost the NK cells in eczema patients, thus allowing these patients to receive the smallpox vaccine.

This article shows that smallpox vaccine research continues today, and that one of the principal aims of the research program is to discover why some people react poorly to vaccinia. That information may then be used to design safer vaccines to protect the population from bio-terrorism. Research on smallpox such as this is one argument for keeping smallpox stocks available - without this kind of knowledge, we would not be able to protect certain groups of people in the event that mass vaccination was needed. This new knowledge has the potential to save lives in the future. Weighing that benefit with the risks of retaining the stores of smallpox, however, becomes extremely tricky.

The journal article is "Inhibition of NK cell activity by IL-17 allows vaccinia virus to induce severe skin lesions in a mouse model of eczema vaccinatum" in the Journal of Experimental Medicine.

The ScienceDaily article can be found at:


W.H.O. to Rewrite Its Pandemic Rules

W.H.O. to Rewrite Its Pandemic Rules

The WHO has announced its intention to redefine how the organization responds to health threats, with the result that swine flu will never be defined as a full-scale epidemic, as it has thus far shown itself to be a relatively benign infection.

The current system was created in response to the avian flu in 2005, but many countries have complained that the point-system encourages undue panic.

According to the current system, which uses 6-points, swine flu is a level 5 threat - there has not yet been continental spread, as the spread of the disease has been due to travelers. Authorities also suspect that the movement of a pig from North America to Eurasia contributed to the current landscape of infection.

While the WHO attempts to maintain a balance between complacency and paranoia, the organization recognizes that there is little opportunity to evaluate the disease's threat, independent of a large-scale outbreak.

Elaine Su

The Next Steps for Swine Flu: Predictions, Protection and Prevention

The Next Steps for Swine Flu: Predictions, Protection and Prevention

In all likelihood, people will need three shots next flu season: one normal flue vaccine, then the two that will be developed for swine flu. Previous vaccines are expected to be ineffectual, and the CDC's current hypothesis is that the elderly are the only fraction of the population that may get away with fewer shots. CDC officials suspect that those born before the 1957 Asian Flu, an especially those older than 65, have antibodies to the flu. However, only 1% of the cases reported thus far have been in that fraction of the population.

Notably, there have not been marked increases in flu mortality rates thus far, but flu season is yet to come. Flu is still a prominent presence on the east coast, and in New York, where many schools have been closed. The current death count remains at 84, and no new cases have been reported since 14 May.

Elaine Su

WHO to Overhaul Alert System

The WHO is to develop a new system for alerting the world to new diseases with the ability to cause pandemics. According to the deputy director-general, Kenji Fukuda, while the exact wording of the new rules cannot be predicted beforehand, the nature of the protocol will include a "substantial risk of harm to people." This will either be in addition to or instead of the principle determinant of the current rules, which is the geographic spread of the disease, even if the infection is relatively benign.

This overhaul is ostensibly in response to mounting international criticism over the implementation of the alert protocol during the swine flu outbreak. According to countries most affected by the the outbreak, such as Mexico, the six tier system in place currently does not account for the lethality of the pathogen. Thus, these countries complain that the system is prone to cause undue panic and substantial economic damage even though the disease is relatively benign. Furthermore, the guidelines for implementing the alert protocol is nebulous. For example, in April, when swine flu was first detected in North America, the alert level was raised from 4 to 5, while no commensurate action was taken as the virus was detected in Europe. This discrepancy is in apparent contradiction to the current guideline which uses the spread of contagion from one continent to another as the premise for raising the alert level. In response, Dr.Fukuda offers that while the presence of swine flu was detected in the latter case, there was no evidence of "community spread", which is technically the spirit of the guideline for raising the alert level.

While the case for changing the current system is convincing, there remains concerns over creating a new system which is too conservative and less sensitive to the rise of potentially devastating infectious diseases. In contrast to determining geographical spread, scientifically establishing lethality is a difficult process which requires a large sample size, meaning that the number of infected must be relatively high before a statistically significant rate can be determined. Thus, by the time the reliable metric for raising the alert is established, valuable time would have already been wasted.

This article raises an interesting question: what would be a good parameter for a global system of alert? My take on this is that perhaps it is the global part of the global system that is the problem. Any rational system of alert should be able to take into account that different regions are at different levels of risk for any particular pathogen. Blanket grades of "alertness" for the entire world or even for continents, with no regard for local, regional infrastructural, environmental, and behavioral patterns, has the inevitable tendency to both cause unnecessary panic in one area while simultaneously not doing enough to warn others.


Source: International Herald Tribune, May 25 2009, p.5.

Blog of the Artist who did the Attic in Jenner Museum

I remember talking in class about our afterthoughts on the Jenner Museum attic and the consensus seemed to be that the artist missed the point and made it too much of theatrical experience. We left the attic feeling confused, terrified (or at least I was after the torso mannequin lurched out at me from behind the door), and distracted from the topic of Jenner and smallpox. Ultimately, the discussion ended with the questions, "What was the museum exactly going for? How did the donators react?"

Well, I found this website from one of the artists commissioned to work on the attic. She chronicles the attic's development from idea to establishment, providing a lot of answers to many of our inquiries. For example, if you're craving to know what exactly was going on in the artist's head behind the attic's design, she provides an answer and says:

"My interest as an artist is in psycho-history: revealing the interplay between psychology and history. Research uncovered an incident in the young Edward Jenner's life, which, for me, goes a long way in explaining this sometimes conflicted man and his work."

...with her ultimate goal stated here:

"And what I hope to do is to get people to question how they judge the ethics of medical procedures - whether they see it as relative (to the social mores of the time) or absolute.

To be honest, to get people to think about ethics at all, rather than "leaving it to the experts will be enough."

Her blog highlights the intricacies and difficulties behind presenting to others about a certain disease through artistic methods. While I originally thought the exhibit was too heavily focused on the artistry and not enough on Jenner and smallpox, I was proven wrong after reading her blog. She conducted a lot of research prior to designing and then constructing the project, reading a lot of Jenner's works and related ones on the disease's impact. She really expresses concern on how to get people to empathize with those harmed by smallpox. Her blog not only explores art theories in relaying the emotions and experiences of smallpox victims, but also ties in a lot of modern day concerns that she and her colleagues face regarding current MMR vaccines and the government health programs.

Anyway, I recommend this site to everyone in this class considering we had such strong opinions on the exhibit. It definitely provides more clarity on the exhibit and I think it less of a sham now; however, I'm not ready to let go of the mannequin incident... I will when I stop having nightmares about it.


Taiwan, NOT 'China Taiwan,' Reports 1 Case of Swine Flu: The WHO's cross-Strait discord and the Political Influence of Disease

Taiwan now has its own, independent listing in the WHO's table of global swine flu cases. This marks a change from before, when it was listed either under 'China, Taiwan" and other titles that suggests that the island was part of China. These series of articles that I'm sharing report the change but I wish to go a little deeper since this event has great personal significance to me.

Most of my family still live in Taiwan and they were there when the SARS epidemic hit in the beginning of this decade. I recall the injustice my grandparents expressed when the island experienced the SARS epidemic a few years ago. Although new cases of SARS and the consequent arose each, making Taiwan one of the most endemic areas in the world, Taiwan was still excluded from the WHO and its global disease monitoring program. It's request to join were rejected by China, who is one of the five nations on the UN Security Council who possesses veto power, because the latter feared that membership would undermine its claim to governance over the island. Taiwan did not receive the WHO's up-to-date information regarding SARS and its spread, despite the island reporting actively and regularly to the international organization. As a result, Taiwan lagged in receiving information regarding proper handling of the disease, leading to several avoidable deaths. Essentially, one nation harnessed the devastating effects of the SARS epidemic to use as leverage in forcing the other nation towards doing its will.

The difference between the global recognition of SARS and swine flu in the cross-Strait relations testifies the geo-political influence that diseases have, both as a unifying and dividing force. SARS and the swine flu elicited responses from the global company displaying how diseases bring nations, who traditionally have little contact due to distance (i.e. my last week's article about Mexico that was found in an Yugoslavian newspaper) and political interest, together. However, the SARS outbreak showed that when politics is thicker than international health concerns, diseases can exacerbate existing social divides.

I am very glad to see how WHO is currently handling swine flu and that it is advancing away from natural epidemics turning into political leverage. Personally, I see deliberate withholding of life-saving outbreak information just as bad as biological warfare. It's scary to think that only a few short years ago, one set of authority were able to do just that to 23-million people who actively contributed to the global health network while the rest of the world watched. I hope that the current trend continues and that global health leaders are able to see that no group of people should be actively prevented from information regarding defense mechanisms for natural health disasters.


Industry's influence on medical research

How much is medical research skewed by its funding? An NIH-funded study out of the University of Virginia sought to answer that question, representing what they say is “the first recent attempt to gather data from the leading research institutions on financial arrangements between medical school investigators and industry.”

The study targeted the 33 US universities currently receiving the most funding for biomedical and clinical studies. It asked researchers about their funding sources, and about those sources’ potential links to “questionable research integrity practices.”

66% of the 703 researchers who responded said they had received industry support for their research—anything from large grants to lab equipment to personal gifts. More senior researchers, not surprisingly, received greater amounts of funding. Males were also more likely to receive industry support than females—77% versus 23% (although this could be viewed as a confound of, or variation on, the “senior researcher” result, since more males are likely senior researchers).

The study’s most significant finding, according to its authors, was that 9% of respondents had “first-hand knowledge” of “compromises to the well-being of research subjects” because of industry sponsorship. Although it’s a small percentage, they argue that “the concern is not that compromising the well-being of human research participants happens frequently but that it happens at all. There should be zero tolerance for compromising the well-being of human research participants in any study, regardless of the source of the study's support.”

35% of respondents noted “compromises to research initiatives,” 28% to “publication”, and 25% to “interpretation of data”.

The found that studies’ ties to industry aren’t always reported to research subjects—meaning that subjects haven’t been informed of researchers’ potential conflicts of interest. This could constitute a breach of ethics by researchers.

They also found that researchers often consider industry support critical to carrying out their work, at all. And, unfortunately, those researchers who found industry support more critical were the most likely to have “first-hand knowledge of,” or be close to, compromises to research integrity.

Studies reporting pro-industry biases have been circulating for years. Harvard Medical School’s Eric Campbell, quoted in an article on the study, expressed hope that further work will examine “the extent to which these [attempts to influence researchers] happen from other funding sources as well.” Patient advocacy groups and government agencies—such as the NIH, who funded this particular study—could pressure research with their own agendas.

It’s difficult to decide whether these findings are noteworthy, or just another in a slew of related surveys on industry influence. Small sample size (due to low response rate) and potential biases when discussing such a sensitive topic make it difficult to come to conclusions about the true degree of influence industry exerts. And, as Campbell points out, influence comes from all sides—not only industry.

At the moment, at least, industry provides crucial funding—and maybe research with some influence is better than no research at all. On the other hand, common sense and history tell us that scientific agendas are worth being wary of.


Sunday, May 24, 2009

Book Review: Speckled Monster

Carrel’s historical fictional novel brings to life Lady Mary Wortley Montagu and Dr. Zabdiel Boyleston’s efforts to bring inoculation into the medical practice of the western world. I am amazed at how she was able to use letters, diaries, newspapers, and other primary documents to reconstruct what happened. By bringing out the characters as humans, she reminds us that they are not just figures in a history book, but takes us through their emotions and social interactions. Looking back on historical achievements, it may be easy to forget that progress can often be an uphill battle that is met with a lot of resistance.

For example, Carrel brings out the courage that these characters had in facing the strong, and often violent, opposition to inoculation. However, they continued to promote inoculation because of their dedication to fighting smallpox, stemmed from having suffered it themselves and having lost loved ones to the disease. After one of his patients dies from inoculation, Boyleston is described to have a personal moral conflict regarding his culpability in the patient’s death. Yet, in just a reading from a history textbook, the reader would not be aware of the characters’ personal motivations and emotional trials. Thus, reading this book makes the achievements and contributions of Mary and Boylseton all the more appreciated.

For those skeptics who wonder how much is true and how much is fiction, Carrel provides a detailed delineation in the “notes” appendage. I myself started reading the book wondering, “How does she know all this stuff?”. The answer is that she probably is making it up, but writing what probably happened based on primary sources. I am most impressed by the immense amount and the vast diversity of her research, digging through current health statistics, historical journals, and personal correspondences. Most of the discourse and communication is based on actual exchanges preserved in letters, while other anecdotes derive from Lady Mary’s granddaughter’s recollections. I also appreciate how Carrel was able to take statistics from sources such as the WHO and contextualize it into the time period. I do wish that she would included footnotes in the novel so that the reader could discern fact from fiction while reading.

Despite the fact that the book probably glorified Lady Mary and Boyleston more than is factually accurate, and that it threw in bits not necessarily historically relevant (love stories and affairs), The Speckled Monster is a worthwhile read for those desiring a fuller picture of the historical events in the history of smallpox. However, it is not for those who only desire the facts, nor for those looking for a literary piece of art. I do wish that a director would become inspired by this book to turn it into a movie; this would succeed in bringing the main historical events to public knowledge, showing the personal side of the characters, and flavoring it with some romantic drama – and the audience would only have sacrificed two hours. (PS I would cast Kate Winslet as Mary, Kevin Spacey as Boyleston, and Will Smith as Boylseton’s slave).


Saturday, May 23, 2009

Sex traffickers threaten women with smallpox

In Madrid, the police have broken up a human trafficking ring that forced Nigerian women into prostitution by threatening them with smallpox, along with assorted other voodoo curses. The perpetrators would entice African women with the prospects of a better life in Europe, and took the women to a voodoo priest before smuggling them into Spain. During the voodoo ritual, the women had to swear that they would not reveal the name of their captors, and body parts such as hair and fingernails were collected. Then the traffickers demanded that the women repay them for their efforts by becoming prostitutes, under threat of voodoo spiritual consequences. According to a Nigerian journalist, Voodoo is a common intimidation weapon used by traffickers. He continues, “If the priest tells them they will get smallpox, then they believe they will catch smallpox.” A similar Dutch based group that trafficked mostly Nigerian children with voodoo was arrested in October 2007.

Although this article may seem to be only tangentially related to smallpox, I think that it reveals a lot about the power of spiritual beliefs associated with disease, including smallpox. In these societies, smallpox still seems to retain a mystical air, used by spirits to punish those who come under their wrath. Of course, misinformation and lack of education plays an important role too, because if the women knew about the risk of smallpox infection (0%) they may not be as threatened by the voodoo tactics.


Friday, May 22, 2009

Book Review: Pox Americana by Elizabeth Fenn

With Pox Americana, Fenn crafts a sprawling narrative detailing the overlooked smallpox epidemic of 1775-1782 in the Americas and the tumultuous times of revolution that surrounded it. While the global devastation caused by smallpox over the past few centuries has been well documented, Fenn’s book offers an uneven but often compelling perspective on the events that shaped America’s birth, deftly elucidating the undeniable influence of smallpox on the course of the American Revolution.

Pox Americana begins with an account of the American army and George Washington’s struggle to fight off both smallpox and the British; the narrative is especially gripping here, as it provides a detailed glimpse into how prominently smallpox factored into both side’s war strategies. Fenn then traces smallpox’s journey through North America by detailing the lives of the various peoples who inhabited America and the constant struggle to coexist with the lethal contagion and carry on with their lives. With the myriad stories of the colonists waging war to the Native Americans running the fur trade, Fenn raises many themes that still resonate today, particularly the use of biological warfare and how the American way of life facilitates the transmission of disease.

The scope of Pox Americana is breathtaking. Fenn clearly poured over many, many sources to craft her portrait of an infant America irrevocably shaped by the smallpox epidemic. The research pays off; the role of smallpox in George Washington’s decision-making process and the tragedy that befell countless Native Americans makes for compelling history reading. Yet Fenn’s narrative is not without its share of flaws. While it may be a function of the historical events themselves, Pox Americana is a very top-heavy narrative; it starts out strong in its depiction of the American Revolution but loses steam throughout the second half of the book, when the revolution is no longer the focus. During this second half the narrative becomes bogged down in repetitive and overlong accounts of Native Americans and settlers dealing with smallpox during the fur trade. Unfortunately, the book never really recovers, losing momentum long before the epilogue rolls around.

Yet Pox Americana’s shortcomings never quite derail the experience. Despite the uneven structure and pacing of the narrative, the sheer amount of quality historical content makes Pox Americana a unique and worthwhile read for anyone remotely interested in learning how one disease helped define the course of a burgeoning country.

-Andrew Plan

Thursday, May 21, 2009

Book Review: The Speckled Monster by Jennifer Carrell

The Speckled Monster is an unwieldy beast of a book. One part history lesson, one part multilayered drama, Jennifer Carrell uses painstaking research to recreate the tale of the devastating scourge of smallpox and two unsung heroes, Lady Mary Wortley Montagu and Dr. Zabdiel Boylston, who battled substantial social opposition to save their cities from the deadly scourge. The story details the horrors of smallpox through the interweaving tales of these two protagonists, starting off with a glimpse into the London high life of Lady Mary Wortley. From there it goes on to establish the upbringing of Dr. Zabdiel Boylston and his rise into the role of maverick surgeon in Boston. The rest of the book sees these two tales intertwining, providing historical and intimate perspectives of how smallpox took its toll on the people of London and Boston.

As a piece of historical fiction, The Speckled Monster manages to do its job as both a historical account and as a legitimate drama. The ‘historical’ side of the book is impressive to say the least. Carrell definitely did her research; close to fifty pages of the novel alone are dedicated to historical notes. Facts and events blend in with intricately reimagined events and dialogue between the key players in the smallpox saga. The integration works a bit too well; I found myself wishing that I could tell when fact ended and Carrell’s reimaginings began.

While reading the book, however, I felt that the 'drama' was lacking. Carrell starts off the book with a portrayal of the growing Lady Mary that comes off as a bit like a teen drama, with melodramatic, even angsty prose. This section definitely could have used some trimming at the very least so as to get into the more interesting smallpox years sooner. Overall the narrative felt too heavy on the subplots and personal drama; I found myself groaning when the momentum would stop to talk about Lady Mary’s strange relationship with Alexander Pope, or Mahler’s diary entries.

Carrell’s The Speckled Monster ultimately reads like a noble failure; while the history aspect of the book is quite compelling in its illustrating of how the smallpox scourge affected individual lives and social dynamics in London and Boston, the drama that Carrell crafts from the stories of Lady Mary and Zabdiel Boylston leaves much to be desired. The book is perfectly passable as afternoon reading, but if it’s just historical fact that you’re after, there are better sources on smallpox that will get the job done.

-Andrew Plan

Wednesday, May 20, 2009

NIH to launch drug development program to target rare and neglected diseases

The NIH is planning to launch a campaign aimed at developing and testing drugs aimed at rare and neglected diseases. According to the article, the NIH usually sticks to very basic science, and has only limited programs for developing drugs.

The initiative will aim to cooperate with the private market by sufficiently "de-risking" the process, since private companies have little financial incentive to develop drugs that only affect a small group of people, but are still subject to the grueling (and expensive) development and testing process.

The program will have approximately $24 million per year, aimed primarily at discovering and researching potential medicines to turn over to the private market for further development.

-Andrew Beck

New cost-effective method for finding the 'on/off' switch for genes

Here's a pretty geeky new-n'-hot with major implications for the economics of the pharmaceutical industry and turnaround time for drug development. UCSF scientists have unveiled a method for identifying large quantities of short hairpin RNA, or shRNA, at a very fast rate. shRNA are basically the on-off switches for genes; they have many potential uses in manipulating genes involved in disease causation. Up to this point finding shRNAs has been a time and resource-intensive process. The new system uses microarrays to synthesize large numbers of shRNA strands, which allows even small laboratories to do significant genetic screenings. So far the researchers have created a library of 22,000 shRNA segments, with plans to create an shRNA library spanning the entirely human genome.

Facilitating the identification of shRNAs that affect the functioning of genes necessary for disease causation has potential to save a large amount of time and money in the crafting of interventions for particularly difficult diseases like HIV and Alzheimer's. This technology could open the floodgates for many smaller labs to move away from fruit flies and delve into mammalian-based research on treatments; previously, the study of individual genes in mammals would cost $100,000-plus to run.

article link:

-Andrew Plan

A promising new malaria treatment...

Researchers at Johns Hopkins University School of Medicine have discovered a new molecular target for the treatment of malaria and a potential candidate compound to address the target. Their research focuses on the function of MetAP2 proteins; these proteins are found in all organisms, including plasmodium falciparum (the parasite that causes malaria), and are essential for the survival of cells.

Recent research has found that interfering with MetAP2 with the antibiotic fumagillin stops malaria parasite growth. Fumagillin causes brain cell death, however, so the Johns Hopkins researchers tested a derivative, fumarranol, on mouse cells containing the plasmodium MetAP2 as well as in live mice. In both cases MetAP2 function was inhibited; with the mice, parasite load was significantly reduced after 26 days, with some mice considered to be cured of malaria.

It's good that researchers are still hard at work on developing new treatments for malaria, as there is increasing resistance to some of the major malarial treatments out there. Hopefully this discovery will facilitate the development and roll out of more efficacious malarial drugs.

article link here:

-Andrew Plan

How Down syndrome works against cancer

I know the following article isn't related exclusively to infectious diseases, but it does somewhat pertain to the class because 1) we discussed chromosomes and genes last class, and 2) we know that there are viral agents of cancer.

As published in the latest edition of Nature, researchers have proposed a theory as to why people with Down syndrome rarely get cancer (people with Down syndrome are only about one-tenth as likely to get solid-tumor cancer as people without the syndrome). People with Down syndrome have an extra copy of chromosome 21 so instead of the usual two copies, they have three chromosomes. Chromosome 21 carries 231 genes including the RCAN1 gene which encodes a protein that suppresses the blood vessel growth needed for tumor growth. Scientists have theorized that the presence of an extra copy of this gene would result in more protein production and thus a possible anti-cancer effect.

The researchers from Harvard Medical School compared two sets of mice - one set had the extra RCAN1 gene while the other set had the normal pair. All mice were then surgically implanted with melanoma or lung tumors. Results showed that the set of mice with the additional protein had less than half as much tumor growth and fewer blood vessels surrounding those tumors as did the set of mice with the usual two genes. An analysis of human fetal tissues also showed that Down fetal tissues had nearly twice as much protein encoded by the RCAN1 gene as did normal tissues.

I know there are a lot of times when students get bogged down by the details of biology; we wonder why we have to memorize all the steps of the Krebs cycle or understand growth factor cascades. But articles like this always remind me that basic biology isn't just information restricted to a textbook; it has real implications, and understanding the biology of a disease facilitates opportunities for interventions.

For the complete journal article:


Tuesday, May 19, 2009

Avian Flu outbreak in China

The Chinese National Avian Influenza Research Lab confirmed two days ago an outbreak of avian flu in Qinghai province China among migratory birds. The county is a major stopping point for migratory birds. So far, 121 birds have been found dead and tested positive for H5N1. The county is removing poultry from the area, disinfecting farms, disinfecting vehicles, and banning outsiders. Bird flu education among the residents is being implemented. So far, no bird flu symptoms have been observed among poultry.

I'm quite impressed that the Chinese were able to mobilize such a rapid response to this outbreak, having learned their lesson from previous infectious outbreaks. I wonder if there are any effects of this outbreak on the farming economy of the county.


Ghosts in the Jenner House!

A photographer who attended a private showing of the attic exhibit we all were thrilled about claims that he captured a ghostly figure in one of his photos. The house is apparently reputed to be haunted, and guesses as to the ghostly figure range from servants of Jenner's to soldiers who at one point resided in the attic. The photographer claims he is sure it is not just light or dust.

I wonder how veritable this is, and whether there is any chance that the museum is encouraging this story to increase publicity?


Monday, May 18, 2009

Over a thousand girls harmed by government mandated HPV vaccine in the UK??

-C. Paula de los Angeles

This unsupported article claims that over 1,000 girls in the UK have experienced negative side effects to the government mandated HPV vaccine, Cervarix, including epilepsy and convulsions. The British government initiated the program to vaccinate all secondary school girls in the fall of 2008, and plan to have all girls under the age of 18 vaccinated by 2011. So far, 700,000 have received the vaccination.

Issues: HPV vaccine has been proven to be effective for secondary school children in the US with minimal side effects. Article does not give any comparative results. Sensationalist article?

News link:

Brain Cancer Vaccine?

-C. Paula de los Angeles

Historically, patients who have brain tumors get them surgically removed. However, almost always, the tumor returns and the patient dies within two years. With these types of tumors, surgery and chemotherapy doesn't seem to be effective.

Dr. Theodore Schwartz, of the New York Presbyterian/Weill Cornell Medical Center, has designed a vaccine that puts a tag on cancer cells, helping the immune system find the cancer and kill it and is currently testing it on patients. Due to the success of initial trials, studies are beginning on larger groups of patients.

Questions: What are the pros and cons of a vaccine to treat a brain tumor? Is this a more cost-effective alternative? How does our immunological understanding of vaccines help us understand other areas such as oncology and neurobiology? At what point would we give the vaccine?

News link:

New n' Hot: Cell Exhaustion in Chronic Viral Infections

Researchers from the Emory Vaccine Center have discovered that chronic viral infections, like HIV and Hepatitis C, actually exhaust the body's immune system. Despite a strong immune response in the patient, these viruses essentially "tire out" T-helper cells after a period of time. Here's how it works:

- T-helper cells find out that a virus is present when they detect bits of virus presented by MHC class I molecules
- These researchers found that mice with a LOWERED ability to present viral proteins to T-cells were initially healthier, because their bodies detected less virus
- BUT the T-Helper cells of these mice became exhausted--and useless--much sooner, because they could not recognize the virus in cells unable to present virus-bits
- T-helper cells presenting MORE viral protein experienced exhaustion LESS

Original article:


HIV and ARV Treatment

A study just came out demonstrating that the mortality rate of HIV patients can be cut in half when ARV therapy is initiated concurrently with treatment for opportunistic infections. The study was conducted by researchers at University College Dublin and Stanford (!). Currently, when patients are diagnosed with AIDS late in the disease process, doctors treat them for their complications (the opportunistic infections) but do not start them on ARVs at the same time because they fear that the two therapies will have negative effects on one another. Basically, the doctors try to treat the acute disease before dealing with the underlying issue. However, this study shows clearly that early ARV treatment cuts deaths in half by 50%.

The study was conducted over 3 years in the US and in South Africa. Not only was the number of deaths halved by treating early, but the T cell counts also rose much more quickly in the patients who were treated early. By improving the immune system of the patient, early ARV initiation allows the patient to then fight infection better. The study has significant clinical implications and is already leading to changes in medical treatment practices. The findings are most relevant to migrant workers and injection drug users, who are often diagnosed with HIV late in the disease progression.

I like this study because it has direct clinical implications - that is, its recommendations can be immediately adopted by doctors and the outcomes of the new practices should become immediately apparent. There is no excuse for bench-to-bedside dilly-dallying...this research can be translated right away into changes that save lives.


Rise in Biodefense labs Upsets Residents

-C. Paula de los Angeles

The rise in biodefense labs that are being built in Boston and other U.S. cities, including the $198 million National Emerging Infectious Diseases Laboratories at Boston University, raises concerns for the surrounding residents.

Questions:To what extent are these institutions protecting us? How strong are the voices and opinions of the residents?

News article link:

Childhood: Order of Vaccinations Helps With Pain

Childhood: Order of Vaccinations Helps With Pain

The pain infants feel when they receive vaccinations may depend on the order in which the shots are administered.

In a clinical trial with 120 infants and observers including parents and independent observers, infants who received their DPTaP-Hib (for diphtheria, polio, pertussis, tetanus and Haemophilus influenzae Type B) before their PCV (for pneumococcal disease) were judged to experience less pain.

Elaine Su
18 May 2009

Drugs Urged for Swine Flu in Pregnancy

Drugs Urged for Swine Flu in Pregnancy

Curses, reporter - your title makes it sound like people are calling for prenatal vaccations.

What the article is actually about:

The risks that come with swine flu are so high for pregnant women (e.g., pneumonia, dehydration, premature labor), that the CDC is recommending treatment with Tamiflu, despite the fact that treatment with antivirals is not normally advisable during pregnancy.

The CDC now advises administering Tamiflu without delay if a pregnant woman begins to show flu-like symptoms, because at that point, the benefits of giving the drug outweigh the risks.

Usually not recommended because it has unknown effects on unborn children, Tamiflu is assumed to be relatively safe, although clinical trials do not exist for pregnant women.

Elaine Su
18 May 09

Cowpox Re-Emerging?

"Between mid-January and mid-February 2009, 33 human cases of cowpox were reportedly diagnosed in France (15 cases, 14 of which were in the north) and Germany (18 cases, 12 of which were in North-Rhine-Westphalia and six in Bavaria."

As we know, cowpox doesn't really constitute a particularly high public health risk for humans, but it's still interesting to see a zoonotic emergence, especially one with such a rich history in infectious diseases. The infected persons were mostly children, and the zoonotic source was shown to be pet rats. Rodents are just one of the main hosts of the cowpox virus- cows and cats also have endemic cowpox numbers in their populations. Other accidental hosts for cowpox include big cats, elephants, and anteaters.

Most past human infections of cowpox have occurred from contact with infected domesticated cats, and while there seems to be no serious heatlh risks in immunocompetent hosts, there are severe and occasionally fatal risks for immunocompromised patients.


Swine Flu...It's Not Over...

The picture of the swine flu outbreak within the past few months is becoming clearer as researchers are compiling more epidemiological data. Scientists working at the MRC center for Outbreak Analysis and Modeling have recently published their key findings in "Science". Among their key findings is that the fatality rate of the H1N1 strain found in Mexico is approximately 4 in 1000 (0.4%), which is similar to the fatality rate of the influenza strain that struck in 1957. Secondly, the rate of secondary infection per infected person (attack rate) is 1.2 to 1.6. Thirdly, in a confined study of the infection in the town of La Gloria, Mexico, researchers have determined that children are more likely to become infected than adults, suggesting that the adults have some degree of immunity; although this effect might be due to behavioral rather than biological differences. While the data is highly uncertain (with estimates of the people infected ranging from 6000 to 32,000 in Mexico alone), scientists are confident that the virus is spreading and is behaving very much like the early stages of a larger pandemic. Luckily, they also extrapolate from the data that this virus is no where nearly as deadly as the influenza strain of 1918.



Sunday, May 17, 2009

Happy Birthday Jenner!

It's Jenner's Birthday: May 17

-C. Paula de los Angeles

A new CDC director!

President Obama nominated Thomas R. Frieden, MD, MPH, to be the new CDC director. He is currently the New York city health commissioner, and in his job, he has been responsible for some controversial acts. Under his direction, New York city instituted a ban on smoking in restaurants and bars and eliminated trans-fat from NYC's menus. He also pushed to make HIV testing a mandatory part of routine medical exams and had the city's HIV program pass out more than 35 million condoms a year. Some call him a "legislator of lifestyle [and] a Fascist of no fun." Libertarians hate him because he denies people of their right to eat food that's bad for them.

Under his direction, the city has expanded collection and use of epidemiological data and has launched an annual Community Health Survey. Before his work as NYC's commissioner, he worked mainly on tuberculosis control programs in both New York City and India.

Random tidbit: Frieden is fluent in Spanish!


Inoculation brought over from Africa

The website is a little abrassive... its a response to the question "How could a primitive African, a slave, have anything to offer sophisticated Westerners"?

The answer given is the tale of Onesimus, a slave of the famous Reverend Cotton Mather, "most notable of all the Puritan divines," and how he potentially introduced inoculation to North American from Africa.

"I have since mett with a considerable number of these Africans, who all agree in One Story; That in their Countrey grandy-many dy of the Small-Pox; But now they learn This Way: People take Juice of Small-Pox; and Cutty-skin, and Putt in a Drop. Then by’nd by a little Sicky, Sicky; then very few little things like Small-Pox, and nobody dy of it; and nobody have Small-Pox any more. Thus in Africa, where the Poor Creatures dy of the Small-Pox like Rotten Sheep, a Merciful GOD has taught them an Infallible Praeservatve, Tis a common Practice and is attended with a Constant Success.”
-Cotton Mather recording an interaction he had with his slave Onesimus. (1721)

When Mather first shared this idea with Boston officials and proposed that it be taken in heavy consideration as a prevention against smallpox, he was immediately turned away when his audience found out that his idea came from his slave. This was in 1721. Mather remained persistent and kept trying to convince officials of Onesimus's (his slave's name) intelligence and the usefulness of the information Onesimus carried.

However, it wasn't until after 5000 people were infected by smallpox, leading to 500 deaths, that Boston took the idea seriously and utilized it. Lucky for them that they did, since in the next epidemic when most of the population was inoculated, only 69 people died.

Personal thoughts: It made me wonder if progress in medical science is currently held back by racism in much the same way in our discussed instance. Actually, I'm interested in the current racial issues of infectious disease. Maybe I'll do my presentation on it.


Revolutionizing disease classification?

Stanford’s Dr. Atul J. Butte, an assistant professor of medicine, is working with a group of researchers to create a human “diseaseome”—a map that links diseases by the genes they’re associated with.

We’ve talked in class about the pros and cons of “bug” versus “syndrome” approaches to infectious disease classification. These researchers are developing another, parallel approach—classification by a disease’s genetic underpinnings.

Genetic classification has many potential benefits, and research so far has uncovered surprising links between diseases previously thought to be completely separate. Similar sets of genes are active in adults who get heart attacks and in young boys with Duchenne muscular dystrophy. The same genes appear to increase risk of diabetes and prostate cancer.

Genetic links could translate into new treatments: For example, researchers are now thinking of testing heart attack drugs for Duchenne, which currently has no drug treatment.

The genetic approach to classification has its drawbacks, too. Clearly, genes don’t significantly affect all illnesses—and aren’t necessarily the most important factor when they do.

So, although some researchers claim that the “diseaseome” will now allow us to “define human disease precisely, uniquely, and unequivocally,” this doesn’t seem, to me, to be the case. Why should defining a disease by its genetic links be any more “precise” than defining it by its symptoms (for example)? The most useful classification system will depend on the disease, the patient, and the particular context. It can't hurt to have multiple disease-approaches in our arsenal, however, and the "diseaseome" looks like it may lead to some innovative ideas about treatment.

The article can be found here!


DNDi makes new drugs for sleeping sickness

The Drugs for Neglected Diseases Initiative (DNDi) has made two new breakthroughs in treatment for African Sleeping Sickness (trypanosomiasis), reports the UK Guardian.

DNDi, a consortium of seven international aid and research organizations including MSF (Doctors Without Borders) and the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR), was founded in 2003 in order to ensure equitable access to drugs and promote the development of drugs for developing-world diseases. It attempts to work off of existing Research and Development (R&D) frameworks by “filling in gaps” and taking on projects that for-profit organizations don’t want to pursue.

The two new treatments, NECT (nifurtimox eflornithine combination therapy) and fexinidazole, will replace existing treatments that are often toxic or hard to administer. (One of those treatments, melarsoprol, kills about 1 in 20 patients who use it.)

NECT has already been approved for use by the World Health Organization. Fexinidazole, promising because it is a simple, single-pill treatment, will start human trials in Paris this year.

Sleeping sickness is relatively unheard of in the US and Europe, but it’s an enormous problem in sub-Saharan Africa, where its vector, the tsetse fly, lives. It infects between 50,000 and 70,000 people each year, and is a primary cause of mortality in some parts of sub-Saharan Africa, ahead of even HIV/AIDS.

After the tsetse fly bites, trypanosomes (the parasites) multiply in human tissues and eventually cross the blood-brain barrier to infect the central nervous system, causing sleep-cycle disturbance as well as confusion, poor coordination, and ultimately death, if left untreated.

It’s wonderful that collaborations like DNDi exist to develop drugs for neglected, incredibly harmful diseases like trypanosomiasis. But it’s still incredibly frustrating to think about how much we spend on refining, marketing, or re-developing new versions of existing drugs in the US every year (think Viagra). I’m not sure how sustainable such collaborations can ever be, or if there’s any way to change the current, profit-driven system of drug development to favor these neglected diseases more of the time.


New and Hot: Video of HIV Transmission between T-Cells

Mar 27 2009

Researchers at Mount Sinai School of Medicine and UC Davis have captured the transmission of HIV between two t-cells on video. The scientists created a molecular clone of infectious HIV that contains fluorescent jellyfish protein and recorded transmission using quantitative high-speed video microscopy (powerful optical microscopy?). The video shows that transmission takes minutes. "Most prior studies of HIV dissemination have focused on free roaming viruses, but this study shows us how direct T cell-to-T cell contact could in fact be the predominant mode of dissemination within the body," said Dr. Benjamin Chen, one of the scientists working on the study.

Link to the videos:

Elaine C

Friday, May 15, 2009

New and Hot: Virus Causes High Blood Pressure

May 14 2009

Scientists have found that cytomegalovirus (CMV) is a cause of high blood pressure and in some cases, atherosclerosis, or hardening of the arteries. CMV is a very common virus that affects between 60 and 99 percent of adults worldwide; you might be familiar with CMV as the cause of mononucleosis.

The scientists tested two groups of mice. One group was fed a normal diet and the other a high cholesterol diet. Mice infected with CMV in both diet groups experienced an increase in blood pressure relative to the control mice. One mechanism for this CMV seems to be an enhanced production of renin, an enzyme directly involved in causing high blood pressure, caused by CMV. In addition, the infected high-cholesterol mice also had atherosclerosis, which suggests that an interaction between CMV and high cholesterol levels leads to hypertension.

Elaine C

Thursday, May 14, 2009

New and Hot- Cell Phones Combating ID?

Check out this interesting article about attempts to use cell phones in third world countries to spread awareness about HIV and other diseases, as well as track populations and predict pandemics. A whole host of organizations have joined together to make better use of mobile phones, including WHO. They claim their efforts have shown a 40% rise in HIV testing, but that number is unsubstantiated. Despite that, it seems like a cool program. They send out texts to people with HIV quizzes and give out free phones and minutes as prizes. Apparently they've gotten good responses. They also are using cellphones to keep health service people connected. It's pretty cool stuff. Check it out:


New Homeland Security Science Chief Nominee Exaggerates BioTerrorism Threat Using Smallpox

-C. Paula de los Angeles

Tara O'Toole may be the new undersecretary for the science and technology development, the primary research and development arm of the Department of Homeland Security. Many are concerned because they believe that her overstatement of the bioterror threat has lead to a more than necessary and greater risk of bioterrorist agents getting released into society by the increase of the number of researchers and research labs handling them.

In one of her simulations, "Dark Winter" O'Toole described a smallpox outbreak that could endanger millions of people in 15 countries. Many other scientists say that she tripled the normal transmission rate for the disease, always guaranteeing a "disastrous outcome".

Is she the right choice? Overly cautious? I guess the debate over her nomination reflects the all-time debate on whether it's worth it to keep dangerous bioterrorist agents around, like stocks of smallpox.

News article link:

On this day in history

-C. Paula de los Angeles

printed in the Chicago Tribune:

On this day in history

May 14, 2009

***On May 14, 1796, English physician Edward Jenner administered the first vaccination against smallpox to an 8-year-old boy.

In 1804 the Lewis and Clark expedition to explore the Louisiana Territory left St. Louis.

In 1948 (according to the current-era calendar), the independent state of Israel was proclaimed in Tel Aviv.

In 1973 the United States launched Skylab 1, its first manned space station.

In 1998 singer-actor Frank Sinatra died in Los Angeles; he was 82. Also in 1998 the hit sitcom "Seinfeld" aired its final episode after nine years on NBC.

In 2004 Britain's Daily Mirror published a front-page apology after photos purportedly showing British forces abusing Iraqi prisoners turned out to be fake.

Article link:,0,2317164.story

Wednesday, May 13, 2009

On the road to better treatment for bacteriral meningitis!

Researchers at the University of Nottingham just discovered how meningococcal bacteria (causes bacterial meningitis which can kill you just hours after the symptoms appear) breaks through the blood brain barrier. There are three specific respiratory tract pathogens that cause bacterial meningitis in children: Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. The scientists just discovered that all three pathogens target the same receptor on human cerebrovascular endothelial cells to allow them to pass through the barrier. If we could interfere with the interaction between the pathogens and the receptor (maybe by blocking the receptors or through some other method), some treatment could be developed to offer alternative protection and prevention against meningitis.

There is a vaccine for meningitis that is approved for people aged 11 and older. It's 83% effective and protects against 4 of the 5 strands of bacterial meningitis. Even then, according the MSNBC, in 2006, only 12% of teenagers received the vaccine (although the statistic is questionable because we don't know if these are ALL teenagers, including those who had already been vaccinated, or only un-vaccinated teenagers). But still, I don't see why you would not get the vaccine if you had access to it. It seems like some movement is being made to push the necessity of the vaccine. Twenty states now require all college students to either get the vaccine or sign a waiver saying that they've read about the diseases.

For more information:


Tuesday, May 12, 2009

New and Hot: How to Predict Pandemics

May 8, 2009

Researchers from the British Colombia Centre for Disease Control released a model that enables us to estimate the basic reproduction number R0 far earlier in an outbreak than has been possible before. The basic reproduction number describes the expected number of new infections caused by a typical individual during a certain period of time. It is an important factor for estimating the final size of an outbreak and can therefore by very useful for global health officials trying to figure out how to deal with an outbreak in its early stages—for example, swine flu.

The model requires three quantities as input; these quantities are apparently relatively easy to measure early on in an epidemic. These quantities are:

1)infection rate probability- for viral diseases, this is related to the viral load of infectious individuals and can be calculated from their blood serum.
2)removal rate probability: how quickly individuals are removed from the scenario through factors such as death, quarantine and other means to reduce social contact.
3)generation interval distribution - rate at which new cases appear.

The typical disease spreads in three phases: in the early stages, the pattern of disease spread is stochastic or random and therefore hard to predict. Later, after more people have the disease, the other phases are more straightforward: exponential growth and then decline of the number of infected individuals. Knowing the basic reproduction number in conjunction with our knowledge of social networks (how often people meet and where) can help predict the spread of disease even while it's in its early, stochastic phase.

-Elaine C.

Scourge Book Review

Scourge: The Once and Future Threat of Smallpox

Jonathan Tucker’s Scourge: The Once and Future Threat of Smallpox is a comprehensive view of smallpox that traces the disease’s history from the beginnings of inoculation in the Far East, through its role in the European conquest of the Americas, to its more recent role in bioterrorism and threats to national security. Tucker’s book is written in a clear, concise style that keeps the information at the forefront. Unlike Richard Preston’s Demon in the Freezer, Scourge is a chronological account of smallpox, and more like a history book than a novel. Although the book tends to introduce figures and names and then forget them as it progresses, in general, Tucker achieves a balance between a wealth of hard data and anecdotal details, so that a reader can either skim through Scourge or pore over the well-researched data.

Elaine Su

When it comes to immunity, women has the advantage

Researchers at McGill University have recently shown that estrogen imparts an extra measure of protection for the fairer sex. In a study on knock-out mice lacking the gene for Caspase-12, an enzyme which blocks the innate immune system's ability to induce inflammation, it was shown that when the human Caspase-12 gene was implanted into a group of these infection-resistant mice, that only males became more susceptible to infection. Researchers were also able to specifically locate the inhibitory binding site of estrogen on Caspase-12, indicating a direct mechanism for the blocking of Caspase-12 by estrogen. This study has implications on future, estrogen-based immune enhancing treatment.



Monday, May 11, 2009

Smallpox and the secrets of the human immune system

An article on smallpox! And it's interesting too...

So University of Florida researchers have discovered that smallpox wrecked havoc in part by disabling the inflammation response that constitutes one of the first lines of defense against disease. They did a systematic examination of all the proteins produced by smallpox when interacting with human DNA proteins. Through this examination they found that a viral protein G1R, when interacting with human nuclear factor kappa-B1, resulted in a high inhibition of inflammation that has few peers in virology. Unfortunately the article does not mention any results regarding the other smallpox proteins that were examined, but the research presented in this article could not only prove fruitful for further developments in smallpox treatments and vaccines, but also for a much deeper and nuanced picture of the human immune response, which could assist other researchers in developing treatments for other diseases.

Article link:

-Andrew Plan

New and Hot: Swine flu costs Mexican economy $2.2 billion

Seems like there are only two things you ever hear about these days: swine flu and the poor state of the economy. Here's a little of both...?

Anyway, I saw this article, and the issue of "economic cost" of disease is a really important one for many reasons, one of which is the issue of disease eradication. Obviously, we're far from even the proposal of eradicating swine flu, but the issue of economic costs and eradication brings us back to smallpox, the eradication of which cost $300 million, and saved the world $2 billion per year (in 1980 dollars..., and according to Scourge).

If the cost of eradicating a disease is MUCH less than even the annual cost the disease inflicts worldwide, doesn't it just make sense to eradicate it? The answer is, unfortunately, sometimes no. Other factors come into play, and I'll actually be doing my presentation on them, so if you're even remotely interested, you can look forward to that...

-Andrew Beck

Frogs in Madagascar

Totally unrelated to smallpox, but still really really cool-

200 new species of frogs were discovered in Madagascar, doubling the currently known number. However, preservation and conservation is hard to accomplish on the world's fourth largest island- with such a rich diversity of species and rare creatures, it should, in my opinion, become a higher priority for Madagascar governments, naturalists, and global citizens.\05\11\story_11-5-2009_pg14_1


Sunday, May 10, 2009

Fear of a Swine Flu Epidemic in 1976 Offers Some Lessons, and Concerns, Today

In the midst of this new pandemic scare, old fears about vaccinations are beginning to resurface. The string of vaccinations administered in anticipation of the swine flue epidemic of 1976 lead to more than 30 deaths "caused" by Guillain-Barré syndrome, a rare neurological condition that causes temporary paralysis.

The exact relationship between the 1976 vaccine and Guillain-BarrĂ© has not been defined, as the Institute of Medicine concluded in 2003 that the “evidence favored acceptance of a causal relationship” but did not "establish" a causal relationship.

Elaine Su