Smallpox 2009

First images of memories being made: unrelated to smallpox but pretty awesome

2009-06-19T13:33:00.000-07:00

Images taken using fluorescent proteins have shown that when memories are formed, new proteins are synthesized locally in synapses. This strengthens synaptic connections and essentially strengthens and reinforces the memory.

Synapses in the brain are constantly changing and adapting, forming new connections. This mutability is central to learning, creativity, and the forming of new synapses--making memories.

An important question has always been how long-term memories are made and stabilized in this changing environment. This study helps provide evidence of regulated translation of localized mRNA at stimulated synapses, which could be the molecular basis for long-term memory formation, and for deficiencies in learning and memory. This is really cool.

http://www.sciencedaily.com/releases/2009/06/090618151331.htm

-Andrew Beck

Book Review: Demon in the Freezer by Richard Preston

2009-06-19T01:23:00.001-07:00

Demon in the Freezer was an interesting, accessible book. Most of its faults, and strengths, derive from the fact that the emphasis is on presenting points of view, rather than on laying out an argument based on factual research.

Preston sandwiches the discussion about smallpox between sections about the anthrax attacks in 2001. He starts with the identification of the spores as anthrax and the mounting concern that it is a bioterrorist threat. He then continues to give a brief history of smallpox and its eradication. The story of Peter Los yields a general familiarity with the disease and then major personalities like D.A. Henderson and Larry Brilliant give Preston a launching point for his chapters about the eradication effort. Next Preston tackle bioweapons. Here he belabors the fact that the Soviets were likely developing weaponized smallpox and anthrax, drawing upon accounts from Soviet defectors and American intelligence. Finally, Preston discusses the variola stores elimination debate and then uses Lisa Hensley as the entry point for the story behind the development of an animal model for smallpox. At the very end, Preston concludes the account of the anthrax attacks and mentions, briefly, how the advance of biotechnology makes it easier than ever to engineer microorganisms and viruses.

Preston frames his story in terms of individuals' stories. He always uses a personality to introduce information about smallpox, and structures his chapters in terms of that person's narrative. One of the fantastic outcomes of this approach is that Preston really brings life to the story of smallpox. Most books describe the progression of clinical symptoms of the disease. Preston describes Peter Los' experiences, and pepper in facts about, for instance, how people who have smallpox remain conscious and mentally aware throughout the entire ordeal. He uses the outbreak initiated by Peter Los to describe what it was actually like to get vaccinated. It was fascinating: according to Preston, nurses jab your arm something like fifteen times with a bifurcated needle that has been dipped into vaccine. I found the concreteness of Preston's writing incredibly gratifying. We have all been reading many books about smallpox, and most of these lay out well-researched claims. Demon in the Freezer, however, made me look at what I knew in a more intimate way. Of course smallpox is a horrible and gruesome disease that caused unbelievable suffering. But following one person for several chapters, reading about the actual experiences, not just the symptoms, of victims gave me a better perspective, and one that I think it important. These actual experiences contain the real significance of smallpox's eradication.

I do wish that Preston cited his facts more often. My main and only criticism of the book is that the emphasis seems to fall on drama rather than researched facts at times. He makes claims, especially in the section about bioweapons, that begs question of his sources. At times he seems to give away information that is supposedly classified; undoubtedly, this is an over-dramatization on his part, meant to make a popular book more interesting. However, the reader still wants to know: where did he get this information? Citing sources would add more credibility to his assessments. Furthermore, because he angles his writing to focus on narrative and excitement, some entire chapters are superfluous. The chapter the time Lisa Hensley cut her glove in the Ebola lab was exciting and I enjoyed reading it, but it didn't really add any insights into smallpox.

Anne was telling me about Preston's writing method and I did some research on it myself. He does do a great deal of factual research, but he also spends a lot of time simply shadowing and hanging out with the people that appear in his books. After he has written the book, he reads sections aloud to the people who figure prominently and then solicits feedback. For instance, he probably read the D.A. Henderson sections aloud to D.A. Henderson and asked for comments. The result is that we get good glimpses into these people who played enormous roles in the history of smallpox and thus have better insights than anyone else into the issues at stake in the elimination debate and the bioterrorist threat. And Preston is quite even-handed about this: he presents both D.A. Henderson, an avid destructionist, and Peter Jahrling, a prominent retentionist, in a respectful, reasoned manner. We can identify with both of these people, and understand that they both have noble motives that underly their opinions.

The overall effect, as mentioned before, is a book that is narrative heavy and peppered with facts—good facts, but floating facts. I think Preston could have cited his sources without losing this important and insight-producing narrative approach. Demon in the Freezer is a popular book, an entertaining read. For people who have already learned a lot about smallpox, it is especially enjoyable because it brings the facts we have learned to life. Getting at the real experiences of people who suffered from the disease and of people who eradicated the disease is crucial for truly understanding the issues surrounding smallpox. Demon does this better than any other book I've read for this class, in spite of its flaws.

-Elaine C

Book Review: "Jenner's Smallpox Vaccine"

2009-06-18T01:12:00.000-07:00

Baxby’s Jenner’s Smallpox Vaccine is an impressive history of smallpox and smallpox vaccination, broad in scope and varied in sources (which was refreshing after the one-source Rotting Face). Essentially, Baxby seeks to outline the controversy surrounding the discovery of the vaccine and the mystery surrounding the origin of “vaccinia” the strain of vaccine that eventually become the norm.

I applaud his clarity in framing the debate in the first chapter. Using numbered lists and other organizational devices, Baxby leaves readers with no doubt about the basic issues he wishes to explicate. From here, he moves to a more general description of the disease, before jumping into the lives of his primary historical figures, such as Edward Jenner. I appreciated his use of scientific studies and data to back up his broad historical knowledge, which lent his text a legitimacy many smallpox or science authors lack, being written by historians with only a cursory scientific knowledge. He is, however, often self-referencing, perhaps a product of the little actual or valid scientific scholarship that has been done on the subject. His use of illustrations and photographs was effective as well; for a disease that is so visually manifested, this is a wise choice.

There are elements of the book, however, that I found less than appealing. Baxby often seems obsessed with who, exactly, received or should receive “credit” for the discovery of vaccine, vaccination, vaccinia, and other key components of the debate. Though recognition is important, his overuse of the word “credit,” sounding like a school examination, and the fact that most, if not all, of those worthy of such “credit” are dead made his impassioned cries seem, at times, rather silly. There are points in the text where Baxby seems to delight in vilifying Jenner; more effective, I think, would have been sympathy to the enormous numbers of Jenner fans in the world, while presenting the alternatives in the same rational, reasoned manner. Finally, Baxby would do well to tighten up his language to avoid ineffective and vague sentences, such as “Some critics had very pertinent points to make on these issues [the safety and effectiveness of vaccination], but some approaches were frankly hysterical” (5) in the middle of a paragraph. By diving right into his subject matter instead, Baxby would make his text both shorter and more exciting to read.

In short, Baxby’s text is important in that it presents alternative views of the smallpox vaccine’s early history that often get lost from mainstream view. Less self-awareness in the writing about his being “the first time this is attempted” (8) and a tone more sympathetic to mainstream readers who may hold Jenner as a hero would contribute to a more readable tone, I think, but Baxby’s book is worth reading. His scientific data is what separates this text from many others.

-Molly

Mad Cow to Cow, to Fish, to Human?

2009-06-17T14:29:00.000-07:00

Dr. Robert P. Friedland has published an article today in Journal of Alzheimer's Disease indicating that prion diseases such as Mad Cow could potentially be transmitted via fish. While this may seem like an irrelevant discovery, it is most certainly not. It seems that America's farmed fish are often fed cow meat- or bone-products. This fact, both surprising and ultimately pretty disgusting, proves just how interwoven the nation's food industries currently are.

Generally, the species barrier provides reasonable protection for non-host animals against infection; even so, Friedland and his team argue, it is possible for a fish to serve as a carrier for the disease without being infected itself. Further, say researchers, it is "possible that eating diseased cow parts could cause fish to experience a pathological change that allows the infection to be passed between the two species." As Mad Cow disease takes decades to show itself in an infected person or animal, conclusive results may not be available until well into the future. Still, Friedland hopes that his article may help sound the alarm and change farmed fish-food before the disease pervades this transmission route.

From my standpoint, simply hearing that the farmed fish industry uses leftover cow products as fish-food is reason enough to change the practice. After all, said Friedland, "Fish do very well in the seas without eating cows."

Article: http://www.sciencedaily.com/releases/2009/06/090616080143.htm

-Molly

Microbiology Porno: The Reproductive Cycle of Variola Major

2009-06-17T14:20:00.000-07:00

For your viewing pleasure:

- Molly, Teresa, Kaitlyn, Andrew, and Elaine S.

A Book Review of Smallpox: The Fight to Eradicate a Global Scourge

2009-06-17T03:12:00.000-07:00

By David Koplow

Smallpox: the Fight to Eradicate a Global Scourge is a thorough, multi-disciplinary overview of the debate whether or not to destroy the remaining known stocks of smallpox virus in Vector Laboratory in Russia and the U.S. Centers for Disease Control in Atlanta, Georgia. The beginning chapters provide readers with introductory knowledge of smallpox – its biology, its history, its use as a biological weapon, and its place as an issue in international environmental and health policy. Although each chapter in itself does not cover every issue of the subject (theoretically, each chapter could have been expanded upon to become its own book), Koplow presents an incredibly multi-disciplinary understanding of smallpox as a biological, historical, and political agent. For example, a chapter about environmental law and policy may seem unrelated to smallpox at first, but Koplow discusses many policy aspects that ultimately both are affected by smallpox and affect the development, use, and distribution of smallpox. Ultimately, each chapter serves as a building block to Koplow’s final two chapters, one of which presents the argument for eradication and the other against the eradication. Koplow is professional and neutral in his presentation of the background knowledge; readers will not know whether he is for or against the extinction of smallpox until the final two chapters.

It is fairly apparent that the book is written for the general public – people who are unfamiliar with smallpox, biological weapons, and public health. For people who know little about these subjects, Koplow writes an incredible introduction to the numerous aspects of smallpox including its basic history and biology and the politics that surround the disease. This book is not tailored for people who are searching for in-depth discussion of the history or biology of smallpox. For people who are more educated about the issues, some sections may be cursory and too general. Still, I appreciated Koplow’s approach to presenting an entire package of information about smallpox.

Perhaps what I enjoyed most about this book is how applicable its content is to today’s world. Through his organization and style of writing, Koplow encourages his readers to think about smallpox as more than just an eradicated virus confined to the pages of a history or biology textbook. He succeeds in equipping the readers with the information and questions necessary to engage in the debate about extinction of smallpox. Furthermore, the framework of analysis and thought he uses to address smallpox could be used for any other infectious disease (such as HIV to which he makes numerous reference). Thus, Koplow doesn’t tell his readers what to think about smallpox but how to think about public health issues in general. Koplow asks the question “should the remaining stocks of smallpox be destroyed?” and he shows that the answer to that question is anything but simple.

-Elizabeth

Structure of HIV Protein Shell

2009-06-16T15:06:00.000-07:00

Remember when we learned in class about capsid morphology? We learned that viruses have 3 different types of morphology - icosahedral, helical, and complex - and that HIV falls within the complex category. I was excited to find today that some new research on HIV, published this month in the journal Cell and conducted by researchers at The Scripps Research Institute, builds very nicely on what we already know about the structure of the HIV capsid.

As we learned in class, the protein capsid surrounds the genetic material of the virus. We also saw pictures of several capsids in class, including (I'm pretty sure) one of the HIV capsid. Previously, scientists knew that the HIV capsid was an arrangement of about 250 hexagonal protein building blocks, called the CA. Sets of 6 CA protein molecules make up hexamers, and the ends of shell are completed with 7 and 5 protein pentamers (remember trying to spot the pentamers?). In the past, the group of scientists who conducted this study visualized these hexamers using electron microscopy, and then x-ray crystallography. However, this study is the first to describe the high-resolution molecular structure of the CA. Growing 3D crystals of the CA hexamer had been extremely difficult, but for this study scientists engineered CA proteins that would provide sturdy links between crystals. As a result, they were able to visualize the CA hexamer at a resolution of 2 Angstroms - an unprecedented level of detail. At this resolution, scientists were able to see the precise location of the side chains on the alpha helices that are responsible for stabilizing the structures. They were also able to see "flexibility" in the structure, as well as connections between the C-terminal ends and N-terminal ends of adjacent CA protein molecules.

This kind of detailed understanding of the HIV capsid structure provides new opportunities for interventions that could break apart or destabilize the capsid. For example, interventions could inhibit assembly of the capsid or facilitate its degeneration. The article mentioned, for example, designing small molecules that could be inserted at strategic positions to destabilize the capsid.

I was excited to read about a study that directly applies something we have learned about - viral structure, and specifically capsid morphology - to the real-life problem of HIV. I think this article illustrates beautifully how basic biological principles and understanding, which can often feel far removed from real life, can have huge implications for public health in the future. Whether or not this structure actually leads to the development of an effective intervention remains to be seen, but it seems to me that the greater our understanding of viruses, especially at the atomic level, the greater the chance that we will be able to intervene effectively.

The article can be found at: http://www.sciencedaily.com/releases/2009/06/090612163537.htm.

-Cooper

Cryptosporidium Enteritis: Swimming Pool Parasite

2009-06-16T14:54:00.000-07:00

-C. Paula de los Angeles

I've always been hesitant to swim in public swimming pools, and the recent reports of the sharp increase in recent years of reports of gastrointestinal illness from use of public pools and water parks has only confirmed these fears.

If one thinks that chlorine can kill any parasite and stop the spread of infectious disease, one is wrong. Cryptosporidium has an egglike shell that allows it stay alive in chlorinated water for up to 10 days. Statistics have shown an increase from 7 outbreaks affecting 567 people in 2004 to 31 outbreaks affecting 3726 people in 2007. However, it is unclear whether the increase is a result of an increase in incidence or reporting.

Epidemiologist Michele C. Hlavsa of the CDC has noted that the development of a treatment for the diarrheal disease, cryptosporidiosis, in 2002 could have led to an increase in detection and reporting. Symptoms include diarrhea and dehydration.

To swim or not to swim? Public health officials encourage people to still swim, but to "be smart about it". To them, this means not allowing children to swim when they have diarrhea. Do not swim in cloudy water. Do not swim in pools with slick tiles or without humming filtration machines. Don't use the pool as a toilet.

With that in mind, I'll think twice before I jumped into a pool this summer.

News link here: http://www.nytimes.com/2009/06/16/health/16water.html?ref=science

Politics and trade offs of swine flu funding

2009-06-16T14:37:00.000-07:00

Kaiser Foundation Jun 5 2009 “White House Seeks More Money For Swine Flu”
http://www.medicalnewstoday.com/articles/152688.php

President Obama has requested an additional $3.1 billion of unspent stimulus funds to be reserved for swine flu, that money coming from a 1% cut “across-the-board” to stimulus programs. The stimulus plan, which so far has mostly been spent on assistance for state Medicate and Social Security, has become an “alluring pot of money” for politicians to take money out of. According to this article, Congress is unlikely to approve Obama’s request, especially with major opposition from Republicans, with the US House Majority leader Steny Hoyer expressing concern about a $2 billion war funding bill that is in congress concurrently with the swine flu proposal.

I find this political funding struggle very interesting because it shows where the government’s priorities lie, and also demonstrate some key questions in the swine flu debate. How much money is appropriate to devote to swine flu? Should we really take money away from stimulus programs, which would help Americans with rising healthcare costs and ameliorate joblessness – problems which we know are happening? Should we take money away from these programs to stockpile vaccines for a disease which for the moment remains mild, with only a potential to become more virulent? It is a question of balancing high probabilities of smaller magnitudes, with small probabilities of larger magnitudes. What effect could Obama’s proposal have on the economy? Will it stall our path to economic recovery, and could it do more harm than good in terms of swine flu? For example, would taking money out of Medicaid, harm our ability to treat swine flu infections in the poorer populations that Medicaid serves – a population which I would guess is more vulnerable to chronic conditions that increase risk of swine flu complications. However, if it comes to a choice between a funding for war or for swine flu, I would choose swine flu any day.

Crystal

Infant Death in Argentina due to Swine Flu

2009-06-16T11:12:00.000-07:00

-C. Paula de los Angeles

One of the concerns about the recent swine flu pandemic is how the flu will fare in the winter seasons.

The World Health Organization has already confirmed 35,928 cases of the virus, including 163 deaths in 76 countries worldwide.

This past week, Argentina, a country now entering its winter months, experienced its first fatality due to swine flu, a 3-month-old baby. Officials do not know how the infant contracted the disease, but its continued perseverance into these colder months is a reason to be concerned.

Questions: What is the ideal environmental/climate of this swine flu to spread?

News article here: http://www.nytimes.com/2009/06/16/world/americas/16flu.html?ref=world

Review: "Scourge: The Once and Future Threat of Smallpox" by Jonathan B. Tucker

2009-06-16T07:04:00.000-07:00

It seems that this is a popular book in this class, and rightly so. Jonathan Tucker’s “Scourge: The Once and Future Threat of Smallpox” is a historical tour de force sparingly littered with scientific errors and skillfully dotted by artistic liberties. No conversation is too private, no location too classified for the near-omniscient gaze of The Tucker. The demi-author is able to reproduce a vivid world of facts and events mostly true to their origins and certainly within the toleration of the people he described. That said, this oeuvre was a thoroughly enjoyable read from beginning to end due to its character driven narrative. I think that in a significant way, this book is a dedication to all the people who made the eradication of smallpox possible. It centers on the quirks and genius of eradication giants such as D.A. Henderson, Larry Brilliant, and Bill Foege. The detailed (and somewhat questionable) accounts of conversations and chance encounters reflects not only the research which went into this book, but also the enormous amount of time Tucker took to interview each and every one of the protagonists which populate “Scourge”.

The central story line is remarkable and is a true exemplar of what is achievable when talented and dedicated people are put together and given the chance to make the world a better place. Tucker’s vivid treatment of the events places the reader in the perspective of someone who is along for the eradication effort; from the highest echelons of the WHO bureaucracy to the most common foot soldier in the war against smallpox, the reader is there with the characters. Dispersed in between the various personality-driven narratives are little tidbits of scientific fact which gives insight into the practical challenges confronting the highly translational science of vaccines. The author does an exceptional job at summarizing the key events which led up to zero pox and he makes a good stylistic choice by quoting Brilliant’s reflection of exactly how profound a moment that was for humanity.

The last third of the book is less of an adventure and more of a discussion on bureaucracy and international politics. Tucker can no longer switch between the contrasting personalities of Henderson and Brilliant and their respective cohorts, but almost entirely focuses on Henderson’s frustrating journey through Washington and Geneva politics. Unfortunately, the pace of the narrative drops off but the quantity of information certainly makes up for it; the author takes us into the classified and shady world of Soviet biological weapons research and leaves us wondering about what exactly is in our next breath of air. At times, Tucker makes it seem as though the places and events described were recorded in person while in actuality they were obviously from secondary sources, most likely interviews with people such as Alibek. All in all, “Scourge” is a well written and well researched book about the people who helped to remove smallpox from this world and also others trying to stop those who contrive to bring it back.

Cheers,
Khang

New and Hot: Recombination and Antibiotic Resistance in Pneumococcus

2009-06-16T04:06:00.000-07:00

In the latest issue of Science researchers in the UK and Finland studied genetic recombination in Streptococcus pneumonia, the bacteria that causes pneumonia and bacterial meningitis.

They analyzed the genetic sequences of recombination loci of 2,024 different pneumococcus genotypes from the MLST database, a database that gives recombination locus sequence data for seven housekeeping genes found in pneumococcal bacteria. Housekeeping genes, according to a quick google search, are simply those genes that are involved in basic cell function are are thus always turned on. Using a Bayesian analysis program, the researchers grouped the genotypes into six clusters based on allele frequencies. They found that half of these clusters matched non-pneumococcal bacteria and the other half matched pneumococcal sub-populations. Most importantly, when they looked at cluster 4, one of the non-pneumococcal clusters, they found that it contained almost all of the non-pneumococcal alleles. Upon further investigation, they found cluster 4 bacteria were associated with higher antibiotic resistance to enicillin, erythromycin, tetracycline, chloramphenicol, and cefotaxime. "In contrast, cluster 1, which almost exclusively contained alleles from one cluster, negatively associated with resistance" (3).

This suggests that those strains of bacteria that exhibit the hyper-recombination, a higher tendency to accept genes from other species, are important in the evolution and spread of antibiotic resistance.

This seems consistent with what we've been learning about viruses--the higher the rate of mutation or recombination, the higher the likelihood a strain will develop drug resistance. What I am not clear on is whether their is a recombination mechanism for pox-viruses as there are for most bacteria? Bacteria, especially when they are of the same species, routinely undergo homologous recombination, "in which short tracts of DNA in the recipient are replaced by the corresponding tract from a donor strain, resulting in a mosaic of DNA from different ancestors" (2). How rare are recombination events for pox-viruses and viruses in general? I know Kaitlyn mentioned theories that vaccinia was a recombination of various strains of pox-viruses...

(1) Science summary
(2) Science article
(3) News summary

-Elaine C

The Greatest Killer: Smallpox in History

2009-06-16T02:07:00.001-07:00

By Donald R. Hopkins

If I had to choose only word to describe The Greatest Killer: Smallpox in History by Donald R. Hopkins, it would be “thorough.” The book is comparable to an encyclopedia in its comprehensiveness of the history of smallpox. Hopkins somehow manages to write about smallpox in all five continents and its history in each of those continents. In addition to discussing the fairly well-known history of smallpox in Europe, he thoroughly chronicles smallpox in East and Southeast Asia, the Pacific Islands, and Africa which I think is rarer and sometimes more interesting knowledge. In doing so, Hopkins blends history and medicine and presents himself as both a doctor and historian with the authority to speak about smallpox.

My main criticism of Hopkins’s novel is how he documents the people affected by smallpox. Hopkins writes in his introduction that he “deliberately chose to linger on the illnesses and deaths of prominent persons…first, because they were bound to be of more obvious consequence to history than the illnesses or deaths of numerous less influential folk” (Hopkins xiv). Ironically though, in listing every single member of royalty that was ever infected with smallpox in the history of the world, Hopkins turns these prominent persons into less influential folk in the minds of the readers. At the end of first few chapters of the book, I couldn’t recall one monarch in European history that had been infected with smallpox (except for Queen Elizabeth I) because they all blurred together in my mind. Essentially, there was nothing distinguishing these monarchs from all the other millions of people infected with smallpox because Hopkins only succeeded in pressing upon the reader that A LOT of people were infected with smallpox.

However, when Hopkins is not listing every single prominent person in the history of the world infected with smallpox, he does write an incredibly interesting account of other aspects of the history of smallpox – how it changed the trajectory of numerous empires, how different cultures responded to the disease, and how the “same despair, tragedy, fear, bewilderment, and mistakes…seen in African and Asian villages…[also occurred] in European palaces, North American hospitals, and elsewhere in the not so distance past” (Hopkins xiv). The organization of the book allows for readers to easily observe the evolution of attitudes and behaviors towards smallpox in the different continents (i.e. his last chapter is called “Erythrotherapy and Eradication”), and although very dense, Hopkins’s writing is comprehensive and easy to read.

In 1806, Thomas Jefferson wrote to Edward Jenner that “future generations will know by history only that the loathsome has existed.” I would not be surprised if Hopkins’s book became the main vehicle for knowing the existence and history of smallpox in the future.

-Elizabeth

Ken Alibek's "Biohazard" Review

2009-06-15T18:38:00.001-07:00

Ken Alibek’s “Biohazard”

In Ken Alibek’s memoir about his work at the USSR’s bioweapons organization, Biopreparat, a new take on the scope of the Soviet Union’s bioweapons arsenal and research is revealed. Along with Pasechnik, Alibekov (as he was known as in Russia) was one of the most informative defectors from the USSR, and because of his high status in the USSR’s military-dominated science ministry and biological weapons, his knowledge of the extent of the research involving tularemia, smallpox, plague, toxins, and anthrax was instrumental in the United States’ understanding of their enemies progress. Though the memoir can become melodramatic and a little heavy handed at some points, Alibek attempts to describe the inherent danger of the USSR’s programs and the danger that could still exist today- the dispersion of USSR seed virus strains, scientists, and knowledge to rogue nations and terrorist operations throughout the world. Once a reader is able to get through Alibek’s attempts at flowery writing and dramatic line endings, the foundation of his book is interesting and terrifying. He explains very simply and in layman’s terms the genetic and biological processes to enable increased understanding of the magnitude of the biological weapons and biomanufacturing he was dealing with. All in all, this book was a great introduction and firsthand account of one man’s moral struggle as both a doctor and a biological weapons engineer, in a time when distrust between countries was rampant, and the knowledge and progress of the USSR’s Biopreparat program placed the entire world at danger.

-Kaitlyn

Along the same lines of Elaine’s Presentation….

2009-06-15T18:23:00.002-07:00

A mathematical modelist from the University of Texas at Austin is using Facebook to track disease spread and to measure how individuals perceive health threats and health challenges. The following questions were asked on a Facebook group to measure public responses to the H5N1 outbreak:

“When did you first learn about the swine flu outbreak?"

"Have you searched the Internet for additional information on the swine flu outbreak?"

"If a vaccine for swine flu became available, would you want to be vaccinated?"

These three questions appeared on Facebook two days after the panic hit regarding the swine flu. The principal investigators involved in this model were part of the of the “National Institutes of Health research program called the Models of Infectious Disease Agent Study (MIDAS) that develops computational models of how infectious diseases emerge, spread and can be contained. The results can help public health officials plan for and perhaps even prevent contagious outbreaks.”
“Key to the researchers’ MIDAS modeling project is surveying people on how they perceive health risks. The researchers will use this information to build a dynamic model that simulates how changes in decision-making influence patterns of disease spread. The model will help them and others identify the strategies that improve adherence to interventions and reduce the spread of disease.”

One of the interesting things regarding this study was how the researchers were planning on using the results: “the group is interested in tracking how people’s answers change as public health officials issue new information or guidance about H1N1. The differences could reflect what happens to people’s perceptions, behaviors and choices as a disease outbreak evolves. Incorporating this information will truly advance the field of disease modeling.”

Disease modeling, while having serious limitations, is being used in interesting and new ways- measuring how media changes public perception and perhaps even affecting behavioral changes for community members.

http://www.laboratoryequipment.com/news-disease-spread-modeling-facebook-061209.aspx?xmlmenuid=51

Enjoy!

Kaitlyn

Injection Safety

2009-06-15T18:23:00.001-07:00

Reports from the Associated Press and the US Army have stated that 16 patients have tested positive for Hep B and C, most likely due to improper injection practices.

“According to the AP, the 16 patients at the William Beaumont Army Medical Center were just a fraction of the more than 2,000 diabetics who may have been exposed to Hepatitis B (HBV) and Hepatitis C (HBC) and other blood borne illnesses. The AP noted that the Army said multiple patients had been administered injections from the same insulin pen. Texas’ El Paso Times reported that each insulin pen is meant for use by one person, but between August 2007 and January 2009, multiple patients were injected with the insulin pens. According to Journal Now, multiple patients were “systematically” injected with the same pen.”

The CDC has been working on a ten year long review of patients put at risk for “potentially deadly, blood-borne infectious diseases”. According to the CDC, over 60,000 patients were places at risk, and thousands of patients have to undergo testing for HBV and HCV due to improper infection control practices.

“According to the CDC’s report, health care personnel failing to follow basic infection control procedures and “aseptic” techniques in injection safety is to blame for the patients’ exposure. The CDC said that syringe reuse and medication, equipment, and device blood contamination were common reasons for the exposure issues.”

The importance of medical hygiene is not an affliction of the past. It’s not only in developing countries- it’s happening in our own backyards, and it’s important that we begin to recognize it and educate our health care workers to the importance of basic hygienic functions.

http://northernvirginia.injuryboard.com/medical-malpractice/deadly-diseases-from-improper-injection-practices.aspx?googleid=259200

Enjoy!

Kaitlyn

Infectious Diseases and Cardiovascular Disease

2009-06-15T18:22:00.001-07:00

Hepatitis C-infected individuals are shown to have an increased risk of cardiovascular disease: “Hepatitis C virus increases the risk of coronary artery disease, a large American study published in the 15th July edition of Clinical Infectious Diseases (now online) has found. The study involved over 160,000 individuals, approximately half of whom were infected with hepatitis C. Despite having fewer risk factors for cardiovascular disease, the hepatitis C-infected individuals were more likely to have been diagnosed with coronary artery disease.”

Other infectious diseases have been associated with cardiovascular disease risk, including HIV and other individuals who are co-infected with both HIV and hepatitis C.

“Even though the individuals infected with hepatitis C had a lower prevalence of traditional risk factors for coronary artery disease, the investigators’ statistical analysis (which controlled for possible confounding factors) showed that the hepatitis C independently increased the risk of such diseases by 27% (adjusted hazard ratio, 1.27, 95% confidence interval: 1.22-1.31). Traditional risk factors for cardiovascular disease were also significant in both groups of patients.”

This is just another example of how little we actually know about the relationship (perhaps symbiotic?) between infectious disease agents, and what used to be considered diseases of lifestyle or unfortunate genetics. Epigenetics are going to be an important part of our medical care in the next few decades, and I think we are going to see many other examples of infectious agents having a role in what were once considered non-infectious diseases and afflictions.

Enjoy!

http://www.aidsmap.com/en/news/FEE39D43-0C66-4EA4-8DC1-0ED557146A6D.asp

Kaitlyn

Orthopedic Registries

2009-06-15T18:21:00.000-07:00

This isn’t exactly an infectious disease related post, but I’m pretty intrigued- having two ACL repairs and two meniscus repairs, this stuff is pretty important to me!

A few senators are pushing for the creation of an artificial joint registry- surgery patients that have been given artificial joints or had artificial devices implanted in them would be tracked and monitored to ensure that no defective devices are being used, or to just rate the effectiveness of the devices implanted. The system is designed to “track how patients fare, reduce unnecessary surgeries and weed out inferior products”, all part of Obama’s new take on healthcare: “comparative effectiveness” reviews in order to identify the procedures and devices that work best. Funding hasn’t been secured yet, but a registry like this has been implemented in other countries with high success rates and patient satisfaction.

“The types of problems associated with not having a registry were highlighted last year by an episode involving a Zimmer hip component called the Durom cup. Though some doctors warned Zimmer the device was failing at an unacceptable rate, the company kept selling it for months while it reviewed patient records in an attempt to determine how frequently the problem was occurring.”

We’ll see if it gets enough funding to go through!

http://www.nytimes.com/2009/06/11/business/11device.html?_r=1&ref=health

Enjoy.
Kaitlyn

Book Review - Pox Americana

2009-06-15T16:21:00.000-07:00

Pox Americana by Elizabeth A. Fenn
Book review by Cooper Lloyd

Elizabeth A. Fenn’s Pox Americana: The Great Smallpox Epidemic of 1775-82 offers a unique and astonishingly well-researched account of the role of smallpox in America’s formative years. Using a plethora of primary documents to support her arguments, Fenn relates the previously neglected narrative of smallpox during the American Revolutionary War. Her more textbook-like descriptions of historical events are balanced with carefully crafted vignettes and individual stories, and the result is a gripping and thorough account of a disease that, between 1775 and 1782, surely changed the course of history.

Pox Americana relates a couple of different narratives, including both the effects of smallpox in and on the Revolutionary War, as well as the effects of the disease on Native American populations. The book coalesces, however, in its depiction of the virus as a powerful and unrelenting force, and in its implicit argument that an account of American history is incomplete without an understanding of smallpox and its movement between and among populations. Fenn’s ability to pull together disparate documents and data to make these points demonstrates not only scholarly aptitude, but also a strong vision and vivid imagination for the events of the past. This combination of scholarship and storytelling is Fenn’s greatest achievement in Pox Americana.

In the first half of the book, Fenn describes the movement of troops in Boston, Quebec, Philadelphia, Virginia, and the South, while in the second half she expands to the American West and the fur trading industry. While describing smallpox separately in each locale, she also shows connections between different outbreaks that ultimately enabled the disease to spread across the continent. Fenn demonstrates clearly that the outcome of the war was determined not only by the course of Variola among and between populations, but also by the response of the army and civilians to the virus. Perhaps most interestingly, she argues that George Washington’s decision to inoculate the American troops was one of his most important decisions during the war – a claim that is substantially supported, if controversial.

Fenn’s book not only succeeds as a historical narrative, but also as a source that comes to bear on present day. Pox Americana, for example, paints a picture of the conditions in which smallpox, as well as other infectious diseases, thrive: cramped quarters in military camps, close and unhygienic living conditions in cities, and an “unbroken chain of person-to-person connections.” Furthermore, Fenn shows the reader, rather than simply telling, the incredible potential of smallpox as a biological weapon, and the reader cannot help but extrapolate to the future. In this light, her book provides an eerie vision of what the future could hold and, one might argue, a case for the rapid and final extermination of Variola from the planet.

While there is little to criticize about Pox Americana in terms of thoroughness, at times it seems that Fenn’s writing simply includes too much and that the book is overloaded with evidence, dates, and facts. By the end, reader grows weary of the constant deluge of information that characterizes the narrative, and finishing the book can feel like a chore. It is hard to blame Fenn, however, for substantiating her argument so completely. Pox Americana chronicles an often ignored but vital piece of American history, and it deserves to take its place as a major chronicle of both disease and history in America.

Book Review: Scourge: The Once and Future Threat of Smallpox by Jonathan Tucker

2009-06-15T15:54:00.000-07:00

Scourge is quite simply the first smallpox-related book that I have enjoyed from beginning to end. Jonathan Tucker truly pulls off a remarkable feat, synthesizing the vast amount of literature into a taut, compelling account of the history of smallpox, the most terrible disease ever to plague mankind. At its core, Scourge is a comprehensive and fairly neutral account of the history of smallpox, from early epidemics in Europe and America to the unparalleled efforts of the WHO eradication campaign to the contemporary debate regarding the fate of the remaining smallpox strains.

Many readers, upon opening Scourge for the first time may wonder: Why do people still care? Wasn’t smallpox eradicated? Tucker answers these questions from the very start with a hypothetical scenario on death row, a potent metaphor for the contemporary debate on whether or not to destroy the remaining smallpox strands. It is a simple device that serves to remind the reader of the current relevancy of smallpox, which helps to support the book in its recounting of early history. He begins the historical account with speculations on the role of smallpox in early civilizations and darts through an account of the epidemics in Europe and America during the 18th century as well as Jenner’s development of the smallpox vaccine.

These events, however, are merely meant to be a primer for the heart of Scourge, which is the discussion of smallpox in the 20th century onward. In the first part of this discussion Tucker devotes full attention to the massive WHO eradication campaign, detailing its early efforts in West and Central Africa to the final push in India and Bangladesh. Tucker wisely anchors the story of the eradication campaign to the personal journey of its director, D.A. Henderson. His rise from an officer of the Epidemiological Intelligence Service to director of the smallpox eradication campaign is rife with ambition and unwitting betrayal, as the unexpected acceptance of his combined smallpox/measles vaccination program proposal strains the resources of the EIS and almost destroys his relationship to his superior, Dr. Alexander Langston. Henderson’s story, as well as the other stories of the individuals involved in the eradication campaign convincingly puts a human face to this chapter in the smallpox story.

The second half of this discussion, focusing on smallpox and biological warfare is compelling as well, although the horrific content would arguably stand on its own in lesser hands. He retraces in detail the Soviet Union’s intentions to weaponize smallpox as an agent of biological warfare and the work of the Vector program, which was devoted to the engineering of viruses for such purposes. Once again Tucker wisely anchors this discussion to the personal stories of the people involved, particularly Kanatjan Alibekov’s progression from aspiring physician to scientist in the Vector program to active anti-biological warfare spokesperson. Tucker captures the perpetual sense of dread and uncertainty regarding whether or not the international community will ever reach a consensus regarding the fate of the remaining smallpox strands. By meticulously recreating the dense web of conflicting interests regarding international security and the possibility of rogue sources of smallpox, Tucker ably conveys the moral and ethical ambiguities characteristic of the debate regarding destruction, which is itself a testament to Tucker’s clear, impartial writing style.

This neutrality is both a source of Scourge’s strength and weakness, depending on the reader’s expectations. Those looking for stirring or controversial commentary regarding the debate on smallpox destruction will be disappointed; Tucker refuses to take a stance, offering general recommendations for the future handling of biological warfare but never personally commenting on whether or not the remaining smallpox strands should be destroyed. Yet the cool, uncalculating eye that Tucker casts on events allows history to breathe and compel on its own; as a result, events like the implementation of coercion tactics in the WHO eradication campaign feel very real and devoid of the sensationalism that generally plagues many historical accounts. While the book may be less controversial because of it, Tucker’s lack of bias preserves the already riveting essence of the narrative and is all the better for it.

As far as smallpox books go, Scourge is hard to beat. Packed to the brim with smallpox history yet accessible to any reader, Tucker’s narrative is a must-read for anyone even remotely interested in smallpox and stands as one of the best introductions to the subject available.

-Andrew Plan

New and Hot: one way the TB bacteria achieves virulence

2009-06-15T12:39:00.000-07:00

A few things were known about how the TB bacteria Mycobacterium tuberculosis infects host cells. It had been previously observed that TB bacteria were engulfed by macrophages, where they proliferate. Researchers also observed high levels of cyclic AMP, an enzyme that regulates certain cell functions, in macrophages that were infected with TB. The mechanism that produced this "cAMP burst" was unclear. And if I understand correctly, how the excess cAMP lead to disease was also not well understood.

A recent study conducted by William Bishai et al has filled in some of the gaps in this mechanism. His group found 17 genes in the TB bacteria genome that coded for cAMP production. They injected mice with bacteria that had various combinations of these 17 genes activated. The results suggest that a single gene called Rv0386 is crucial; bacteria with the gene outperformed all other microbes. Hence, they showed that "among the 17 adenylate cyclase genes present in M. tuberculosis, at least one (Rv0386) is required for virulence" (2), that Rv0386 is one of the genes that produces the cAMP burst.

Next, they suggest a further mechanism for how the cAMP burst contributes to the disease. Not only does the Rv0386 gene encode for cAMP, it also facilitates the delivery of the bacterial cAMP into the macrophage cytoplasm. In the cytoplasm, the excess cAMP sets off a chain reaction that results in the host cell producing a lot of TNF alpha, a protein that causes inflammation. Mice with the activated Rv0386 gene activated produced ten times as much TNF alpha in their lungs than mice that lacked the gene. Furthermore, excess inflammation caused by TNF alpha may be linked to the formation of lesions characteristic of TB called granulomas.

(1) News Story
(2) Nature Article

-Elaine C

Book Review - Smallpox: The Fight to Eradicate a Global Scourge

2009-06-15T03:24:00.001-07:00

Smallpox: The Fight to Eradicate a Global Scourge by David Koplow
Book review by Cooper Lloyd

David Koplow’s Smallpox: The Fight to Eradicated a Global Scourge is a perfect read for the newcomer to the study of smallpox. Koplow sets out to provide a basic overview of the disease and its surrounding debates, and he successfully realizes this goal. Extremely detailed discussions are left for other writers; Koplow’s aim is to appeal to reader who has little scientific knowledge or background in the issues surrounding smallpox, and to leave him or her equipped to understand the virus’ continuing significance and engage in the debates surrounding its extinction.

Koplow structures Smallpox in chapters that, one-by-one, build up a multi-disciplinary understanding of smallpox. Koplow begins by discussing the history and biology of smallpox – the bread and butter, really – but then adds additional layers of understanding while ultimately crescendoing to a debate of sorts over whether smallpox should be exterminated from the planet. In terms of chapter content, the book moves from the history, biology, and use of smallpox as a biological weapon, to some related background in environmental law and policy, to the role of the WHO and the morality of extermination, and finally to the arguments both for and against extermination.
In the first two thirds of the book, Koplow provides a well-rounded, if cursory, understanding of the disease and the fundamental issues at stake in its continued existence. Koplow’s treatment of the history of smallpox is compressed into only a few pages, yet he mentions most of the important points, touching on the origins of the disease, its role in ancient history, past treatment regimes such as inoculation, and the global eradication program. In the following chapter on biology, Koplow describes viruses from ground zero, also treating topics such as genetic engineering, genetic alteration of smallpox, and the goals of smallpox research. Koplow next discusses smallpox as a biological weapon, moving chronologically through history to situate the current situation within the context of policies that have evolved over time. The chapter on Environmental Law and Policy raises issues that are often neglected in the study of smallpox, such as biological diversity and the bearing of both US and international law in the debate over the extermination of smallpox. Finally, the chapter on the WHO discusses smallpox within the context of the organization that has been such a major player in its eradication, while also answering the readers’ questions about where the current variola stocks reside and why the extermination of the virus is taking so long; the chapter on morality treats the philosophical debates about the role of man in the manipulation of nature.

Koplow uses all of these chapters bring up various points to which he will return in the last two chapters, the first of which treats the case for extermination and the second the case against extermination. These two chapters synthesize the arguments from various disciplines, allowing the reader to understand how several lines of argument apply to this complex question. While some arguments may at first appear to repeat points brought up earlier in the book, the reader ultimately emerges appreciative of Koplow’s attempt to draw together all of the information presented in the preceding chapters. Furthermore, Koplow organizes these final chapters in terms of numbered arguments and rebuttals, which provide a clear framework and allow the reader to move back and forth constantly, considering both sides of the arguments. The arguments themselves are written in non-technical language – the kind of arguments that one might encounter when talking to a friend (for example, Argument 1 in The Case for Extinction: It costs more money to continue to store and work on this stuff). The clarity of these arguments helps draw the new scholar of smallpox into the debates at the very heart of the disease.

In his conclusion, Koplow offers 12 recommendations for the future, including his own take on whether or not to retain the stocks of variola (you’ll have to read the book to find out his opinion); having taken us through the arguments on both sides of the debate, it only seems appropriate that Koplow allow the reader to understand in the end where he comes down on these issues. Appropriately, however, he reserves this injection of personal belief for the very end of the book and thus spends the majority of his time presenting the arguments and rebuttals quite impartially. Koplow’s policy prescriptions are insightful if controversial, but one wonders whether anyone besides the casual reader will ever see them. Furthermore, they are often too general to be very helpful; for example, Recommendation 7 states that we should, “Address the burgeoning bioterrorism threat directly.” The two paragraphs that follow provide no clear vision of how this should come about.

Ultimately, Smallpox is an accessible read and one that fills a gap in the smallpox literature by addressing the debates over the extermination of smallpox in a simplified way that the general public can understand and take part in; however, to a reader more educated in the issues surrounding smallpox, Smallpox will surely be too simplistic to be of much use. One of Koplow’s best devices throughout the book is the structuring of his chapters using questions as headings; for example, a biology section is entitled, “Is a virus alive?”. Throughout the book, Koplow anticipates the readers’ questions, but in the end, the reader is left with a million unanswered questions. Perhaps, however, this is Koplow’s great achievement; he provides the reader with a base knowledge that equips him or her to ask questions with a new level of sophistication, to tackle more detailed works about smallpox, and to engage constructively in the ongoing debate.

Book Review: Smallpox the Fight to Eradicate a Global Scourge by David Koplow

2009-06-15T02:29:00.000-07:00

Smallpox: the Fight to Eradicate a Global Scourge is a thorough treatment of the debate about whether or not to eliminate the last known stocks of variola. Koplow's writing is lucid and accessible, and he is good about delineating purely speculative evidence from more substantial evidence.

His book is thorough. The first six chapters either cover general background about the disease or lay the groundwork for arguments forwarded in the final three chapters. This includes general background on the history of the eradication effort, the biology of viruses and the history and authority of the WHO. Koplow also gives background to orient the reader for arguments laid out in chapters 7-9. He discusses environmental law, especially as it relates to biodiversity and endangered species legislation to prepare for later questions about whether the virus should be protected on environmental or moral grounds. Because some of the most important arguments about whether or not to eliminate the variola stocks relate to national security concerns, he discusses biological weapons (BW)—international agreements on BW use, previous instances of BW use, perceived threats in post 9-11 world.

At times Koplow is overly thorough. Although he admirably wishes to give the reader a strong understanding of the history of environmental legislation, most of this background is not pertinent to smallpox. He readily admits this, writing: “In sum, the law of environmental protection...is not directly relevant to the question of extermination of the variola virus” (136). His treatment of bioweapons is a little better, but he fails in many places to relate his examples back to the question at hand. For instance, Koplow mentions the anthrax scare multiple times, but only to convince the reader that BW is a real threat. He could have drawn more specific and useful connections to smallpox by, for instance, discussing relevant epidemiological differences between anthrax and smallpox, or whether one disease is more weaponizable than the other, or whether one is easier to identify and diagnose.

On the good hand, Koplow's insistence on covering issues that don't directly relate to smallpox leads us to think about issues in broader or more interesting terms. In spite of the fact that environmental law is largely irrelevant, it was interesting to consider the smallpox extermination debate in terms of endangered species protection. More than anything, such considerations shed more light on our feelings about endangered species than on smallpox. For instance: “Why do we extend special recognition to big creatures and not small?”

Finally, a minor flaw in the last three chapters was Koplow's tendency to show his hand while supposedly giving even-handed accounts of the extermination debate. It is clear, for instance, that he believes elimination would be hubristic when he portrays the side in favor of extermination as saying that humans “play God all of the time” (195). Nevertheless, the critical reader will be able to discern Koplow's biases and can still learn a lot from this book.

Elaine C

Pox Americana Book Review

2009-06-14T19:16:00.000-07:00

Pox Americana: The Great Smallpox Epidemic of 1775-82

Elizabeth A. Fenn’s Pox Americana is a well-researched account of smallpox in North America, from its role in the American Revolution, to its presence in Mexico and the decimation of populations it caused in the American West. The sheer amount of information in Fenn’s book is remarkable, and each page is filled with first-hand accounts, cited statistics and figures that would otherwise be lost to history. Fenn begins with a recent history of smallpox, then works backwards, offering insight and little known facts, from laws in Pennsylvania that forbid variolation, to the fact that Native American treatments were as ineffective as European treatments, a South Carolina ordinance that called for guards outside pox-infested homes, and a Massachusetts law ordering red flags to be flown outside houses with smallpox victims. A book that admirably accounts for multiple fronts of the battle against smallpox in North America, Pox Americana recognizes European efforts to help Native Americans counter smallpox in addition to chronicling the biological warfare that settlers often used against indigenous peoples. In a style that is concise as much as it is conscious of the profound impact smallpox has had on the American psyche, Fenn uncovers an obscure chapter of history with sensitivity and scholarship.

Elaine Su

Book Review: Demon in the Freezer by Richard Preston

2009-06-14T09:02:00.000-07:00

In Demon in the Freezer, Richard Preston presents a chilling revelation of the threat of bioterrorism in the 21st century. Using the lens of the anthrax “Amerithrax” attacks in the U.S. following September 11th, Preston dissects the current international biological weapons climate, focusing on the threat posed by humanity’s most feared and devastating killer—smallpox, or the variola virus.

Preston opens the book in October, 2001, with the discovery of an anthrax-laden letter addressed to U.S. Senator Tom Daschle. The investigation of the source of this crime and the fear that smallpox was involved forms a loose plotline for the book, with many tangents providing historical background recounting the eradication of smallpox in humans and the subsequent debate regarding the destruction of the reserves of the virus. Preston astutely draws upon the fear that arose from the anthrax scare to contextualize the threat of similar use of the variola virus, which has otherwise been forgotten by most of society because of its successful eradication, but which would have even more condemning implications than anthrax if it were successfully deployed in an attack.

After establishing the potential for disaster of smallpox-laced anthrax, Preston launches into a brief history of smallpox and its eradication, introducing the ambiguity of current locations of strains of the virus. Despite the existence of only two World-Health-Organization-sanctioned holding places (the Center for Disease Control in Atlanta and the Vector Laboratories in Russia), there is fear that smallpox still exists in back-room “freezers” elsewhere in the world, resulting from either innocent oversight or, more frighteningly, insidious intentions.

The majority of Demon in the Freezer is devoted to establishing the real potential of a biological attack using smallpox, and the devastation that would result. Preston accomplishes this by weaving together brief chapters and anecdotes following different characters, such as introducing the stories Vladimir Pasechnik and Kanatjan Alibekov (Ken Alibek)--two ex-Soviet scientists specializing in biological weapons who defected--to reveal the scale of the Soviet biowarfare program of the 1990s, and following the lives of government scientists and officials such as Peter Jahrling in their pursuit of progress in developing antiviral treatments for smallpox.

Whenever authoritarian knowledge of smallpox and wise insight regarding its use as a weapon is desired, Preston turns to D.A. Henderson, head of the Smallpox Eradication Program, and consensus smallpox know-it-all. Henderson serves almost as an omniscient, mystical character, whose interviews are cited whenever he really wants to hammer a point home. According to Henderson, “dropping an atomic bomb could cause casualties in a specific area, but dropping smallpox could engulf the world.” And regarding how best to solve our current dilemma: “What we need to do is create a climate where smallpox is considered too morally reprehensible to be used as a weapon.”

This technique of introducing concepts, details, and arguments through individuals’ eyes is one that Preston relies heavily on, and it works. Because of it, Demon reads like a sci-fi page turner, and through our sympathy with each new character we feel the triumph of eradication, the heartbreak of the world’s paralysis in destroying the last strains, and the very real fear of the potential for a biological attack using smallpox. Seemingly every chapter ends with a generic all-encompassing statement summarizing—in case we’ve forgotten—the stakes of such an attack. On page 285, Preston exemplifies this by saying, “virus engineering is cheaper than a used car, yet it may provide a nation with a weapon as intimidating as a nuclear bomb.”

All in all, though such textbook suspense-novel cliffhangers run rampant in Demon in the Freezer, Preston has clearly done his homework, and the reader emerges with a very clear and entertaining overview of the history of smallpox eradication and the post-eradication tension, after having encountered everything from suspense to historical accuracy to scientific introduction along the way. Yes, Demon in the Freezer can be enjoyed by the average fiction reader, but it is a true, incredibly informative, and resonating account of an issue with a historical importance and a current relevance that deserves as much attention as it can get, so, despite some simplifications and corny devices, Preston’s attempt at bringing the smallpox issue to the mainstream is more commendable than anything.

-Andrew Beck

New and Hot: Vaccines for Babies!

2009-06-14T06:54:00.000-07:00

Researchers at the Children's Hospital in Boston have potentially found a way to stimulate immune responses in newborns. This could reduce infant infection rates and increase the efficacy of vaccines given at birth.

During her guest lecture Dr. McShane mentioned that one advantages of vaccinating at birth is that it is doctors can vaccinate a greater number of people when they do not rely on follow-up appointments. But, as we discussed last Thursday, there are problems with vaccinating at birth. First, newborns have inherited immunity from their mothers for a few weeks or months after birth. Second, the immune responses of infants are impaired (2), which leaves them vulnerable to infection and decreases the efficacy of most vaccines. These are two of the reasons why most vaccines are administered when the baby is two months old (except for Hep B and BCG which are given at birth).

Dr. Ofer Levy 's research suggests that one of the key differences between adult and newborn immune responses is the efficacy of their Toll-like receptors, or TLR's. According to Wikipedia TLR's are receptors on the surface of white blood cells that recognize molecules derived from microbes and activate an immune response. TLR's are part of the first line of defense against infection.

It turns out that in infants, TLR's generally trigger a weak immune response with the exception of TLR8, which triggered a robust immune response in antigen-presenting cells. Stimulating TLR8 could enhance immune response in newborns, reducing infection levels and increasing efficacy of some vaccines administered at 2 months. With funding from the Bill and Melinda Gates Foundation, Levy is now testing TLR8 stimulators in human cells and in animal models.

-Elaine C.

(1) News Story about Levy's Research
(2) Review Article on Vaccination for Infants

Now that we're in a Swine Flu pandemic, what about vaccines?

2009-06-12T14:52:00.001-07:00

-Crystal Zheng
This is in response to: “Drugmakers rush to produce a swine flu vaccine” Associated Press http://www.google.com/hostednews/ap/article/ALeqM5i-Qd-q3ALSGUV0tZqwFVoy1GlGfQD98P8DRO4

With yesterday’s raise of the pandemic flu level to phase six, signaling the start of the first flu pandemic since 1968, a natural question that arises is that of vaccines. As of right now, there is no vaccine for swine flu, and seasonal flu does not seem to provide immunity (although no studies have been done to this effect). Prior to yesterday’s announcement, the WHO website indicated that a swine flu vaccine could be ready within six months. However, now that we are officially in a pandemic, vaccine companies have pushed up that deadline, with many including GlaxoSmithKline and Sanofi-Aventis announcing that they would be ready to mass produce a vaccine for swine flu within weeks. The traditional flu vaccine is made in chicken eggs, but Novartis has developed a swine-flu vaccine that uses a cellular method, which may be faster. However, this new technology will not contribute significantly to our vaccine stocks, since the majority of vaccines will still be made using chicken eggs. The WHO estimates 2.4 billion doses of swine flu vaccine could be ready within a year.
Still, I have a lot of questions: first, who will get access to those vaccines? How will we prioritize vaccination? Will we vaccinate everybody, or promote vaccination for only at risk populations? Most of the developed countries began preparing for a pandemic long ago by signing contracts with vaccine companies to acquire sufficient supply for its populations. Many less developed countries will not have access to vaccine, not only because of cost but also due to politics. The WHO has asked vaccine companies to reserve a portion of their supply for poor countries. While some companies have helped, for example GlaxoSmithKine has donated 50m doses of vaccine, in practice, vaccines generally don’t leave the country of production until everyone in its home country is vaccinated, regardless of promises.
The lack of vaccines in developing countries is particularly disconcerting because these countries are more vulnerable during a pandemic. Their populations have higher incidences of underlying conditions, such as chronic disease and malnutrition; development lags behind, making them more susceptible to secondary infections; the population is younger and more densely packed in urban areas, facilitating spread; finally, health systems are not adequate to treat the large influx of patients that would seek treatment in the case of a pandemic. While it could be considered fortunate that so far swine flu has been contained to the more developed countries, its spread to less developed countries may not be far away.
Another challenge is to balance production of swine flu vaccine with seasonal flu vaccine. The production capacity of vaccine companies is limited, and resources shifted to swine flu vaccine will have to trade off with seasonal flu. What is the right balance to strike, considering that swine flu so far has generally caused mild symptoms and has a smaller mortality rate than seasonal flu, which will continue to kill tens of thousands.
In my opinion, we cannot allow swine flu to let us forget completely about seasonal flu. To this end, we must promote and prioritize strategies that would have benefits for both swine and seasonal flu, such as improving access to antivirals and antibacterials that can be used as treatment options for both flus, promoting basic health behaviors and knowledge at the individual level, and capacity building, such as training emergency health technicians.

It's Official: Swine Flu Pandemic

2009-06-12T14:39:00.001-07:00

The WHO yesterday (June 11th) raised the worldwide alert on the swine flu outbreaks to level 6, the highest possible level. This upgrade in alert status is due to the fact that the H1N1 flu, which is now found in over 70 countries, has transitioned from travel-related spreading to community spreading, which is when secondary cases are rapidly spreading. This announcement has nothing to do with the severity of the virus, however, since the current alert gradations do not account for lethality (see my previous blog post). It is rather merely an acknowledgement that the virus is now spreading within the populations which it gained access to after being carried from one continent to another (level 5).

While there are new guidelines and procedures recommended by the WHO that accompanies this declaration, the situation does not become much different. Governmental health ministries from countries around the world have been bracing for larger scale outbreaks than have been seen in the previous few months. In the US, efforts are underway to produce an effective vaccine, although there are still questions as to whether the putative vaccine will be produced in quantities high enough to protect the entire population.

Cheers,
Khang

Source: http://www.sciencedaily.com/releases/2009/06/090611152252.htm

Thinking outside the box for malaria vaccines

2009-06-11T00:12:00.000-07:00

Scientists at the University of Maryland are working to create a genetically-modified super-mosquito, capable of carrying many more of the parasites responsible for causing malaria in humans. They're doing so because Sanaria, Inc. is trying to develop a vaccine using live malaria. The motivation is based off tests that were held years ago on Sanaria's CEO and some colleagues, in which they purposely exposed themselves to low-levels of malaria. The parasite stayed harmlessly in their livers, but they developed immunity to malaria for about 10 months. Sanaria is now developing a vaccine, but it takes 3000 mosquitoes to produce one dose, so they're trying to genetically engineer mosquitoes with more capacity.

Another lab at Maryland University is also helping to do just the opposite--hinder mosquitoes' malaria-carrying capacity and infectivity.

Both are ways of "thinking outside the box" about malaria vaccines, but as of now, both are very small, rudimentary steps. But steps, nonetheless.

http://www.redorbit.com/news/science/1702263/malaria_researchers_turn_to_mosquitoes_to_fight_disease/

Andrew Beck

W.H.O Recommends Rotavirus for All Children

2009-06-10T11:26:00.000-07:00

-C. Paula de los Angeles

In a statement last week, the World Health Organization recommended that all children be vacinnated against rotavirus, a disease that causes fatal diarrhea in 500,000 children a year. Without the vaccination, almost all children get infected with rotavirus by the age of three. Fortunately, children are administered rotavirus drops in the United States. An overwhelming 85% of the yearly deaths due to this disease occur in developing countries in Africa, Asia, and Latin America this is not the case.

The endorsement by the W.H.O will allow donor money to be used for the vaccine. The urging of the WHO to recommend this vaccination stems from clinical trials in South Africa and Malawi showing that the GlaxoSmithKline vaccine worked even in areas with "poor sanitation competing virus, high infant death rates, and mothers with AIDS". A competitor Merck vaccine is being tested in other countries.

Where does the money come in? Currently, the vaccine costs $20 and must be refrigerated (which is difficult in places that lack electricity). Much of the donor money has come from Dr.Tachi Yamada, president of global health at the Bill & Melinda Gates Foundation, very much an advocate of the vaccine.

Personally, I think this is a great example of the power of W.H.O. Not only do people care what the W.H.O recommends, but such an endorsement allows for donor money to be used for the vaccine. In some ways, I think it reminds me of the need for institutional help and financial aid to support the idealistic views of many public health workers or citizens of the world who want to effect change in the places that need it the most.

New arenavirus discovered as cause of hemorrhagic fever outbreak

2009-06-10T05:52:00.000-07:00

A new arenavirus called the Lujo virus was identified as the cause of a highly fatal hemorrhagic fever outbreak in Lusaka, Zambia and Johannesburg, South Africa in September and October of 2008 in South Africa after the air transfer of a critically ill person from Zambia. Of the five cases observed, four passed away (the originally ill patient, a paramedic, a nurse, and a member of the hospital staff who cleaned the patient's room). It is the first new hemorrhagic fever-associated arenavirus from Africa identified in nearly four decades. Using genetic extracts of blood and liver from the victims, researchers found through unbiased high-throughput sequencing that the virus is distantly related to Lassa virus and Lymphocytic choriomeningitis virus (LCMV). Lassa virus causes an acute hemorrhagic fever that causes approximately 5,000 deaths a year in West African countries. Lymphatic choriomeningitis is a rodent-borne viral disease that causes meningitis or encephalitis. About 5% of the US population is infected with the virus.

As mentioned before, the researchers used a technique called unbiased high-throughput sequencing to identify the new virus within just 72 hours. Lipkin, one of the professors responsible for the identification of the virus, said, "it is reassuring that we now have the tools needed to rapidly detect and respond to the challenges of unknown pathogens. A key challenge that remains is deployment of these technologies to the 'hot spots' where new killer viruses frequently emerge. We remain committed to this important public health effort as it represents a unique opportunity to prevent the next pandemic, be it a threat like HIV or SARS." It is exciting that we possess the technology to identify new viruses, but like Lipkin said, can we feasibly use this technology in these "hot spots" which often have weak infrastructure and a lack of resources? I think this case highlights the gap between research conducted in laboratories and action on the ground. There needs to be an effective and feasible delivery mechanism, and I hope that there is more research performed to make this technology more accessible.

For the full article: http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000455

-Elizabeth

US To Fund More Biodefense Programs

2009-06-10T04:11:00.000-07:00

The National Institute of Health is renewing funding for research centers that study infectious diseases and the bioterrorist efforts that could arise from particular disease. Ten of the existing centers are receiving $455 million over five years, and this includes the creation of another center in the Pacific Northwest.

Do we think smallpox will be included in this new funding???

http://www.globalsecuritynewswire.org/gsn/nw_20090609_9066.php

Enjoy!

Kaitlyn

Semantics in the Health World?

2009-06-10T03:46:00.000-07:00

The NY Times printed an article recently regarding the medical jargon and issues with communication that arises in the international health world. With the recent swine flue epidemic, the various words and definitions that are associated with public health became glaringly apparent. What exactly does "pandemic" even mean? Health officials have yet to tell the public exactly what the word even entails, even though the word is instrumental to the WHO's six stages of outbreak levels for infectious diseases.

"Dr. William Schaffner, the chairman of preventive medicine at Vanderbilt University, said that “we, the public health community, deserve to be chided” about the confusion.

“We ought to be able to do a better job in communicating in an understandable way,” he said in an interview.

Scientists like to assert that theirs is an exact discipline. But like the terms “evidence -based medicine” and “peer review,” pandemic turns out to be another example of imprecise vocabulary that doctors use every day, assuming everyone understands their meaning. "

Although journals and textbooks seem to use "pandemic" liberally, they rarely, if ever, actually define the term.

For posterity's sake, here's what Merriam Webster says:

pandemic- a pandemic outbreak of a disease; occurring over a wide geographic area and affecting an exceptionally high proportion of the population

Super helpful, right?

Health needs to become more accessible and communication routes between health officials and communities need to be more clearly defined and traveled more often. This is the only way health will become a global effort and a global success. Everyone needs to become involved; jargon and foggy words cloud the efforts.

http://www.nytimes.com/2009/06/09/health/09docs.html?em

Enjoy!

Kaitlyn

The Evolution of a Virus

2009-06-09T15:00:00.000-07:00

-C. Paula de los Angeles

Science reporter specializing in plagues and pestilences , Donald G. McNeil Jr., speculates on the possibility of a virus, like swine flu, evolving into something more lethal (so far, there have been only 139 confirmed deaths worldwide). Citing numerous scientists, McNeil uses Darwinian logic and rhetoric to argue that there are no evolutionary or selective pressures for the current swine flu to evolve into anything else, despite flu viruses being highly mutable in general .

It's ability to invade human noses and spread through merely coughing is "near-perfect", according to Dr. W. Ian Lipkin, director of the Center for Infection and Immunology at Columbia University’s Mailman School of Public Health.

Structurally, flu viruses are merely eight short strands of RNA that code for 11 proteins. One of most compelling reasons for the current swine flu virus to stay as it is and not develop into a more vicious one is its lack of essential genes, the ones that code for proteins PB1-F2 and NS-1, thought to be involved in lethality.

However, there is a potential of a more vicious swine flu in the possible development of resistance to the antiviral drug Tamiflu, which is currently used to treat it.

Hopefully, the swine flu stays as it is, but perhaps only time will tell...

pandemic defined, for the people

2009-06-09T14:13:00.000-07:00

-C. Paula de los Angeles
\pan-ˈde-mik\: occurring over a wide geographic area and affecting an exceptionally high proportion of the population

The rhetoric of science is powerful. As we've witnessed time and time again, the public's interpretation of science can be dangerous and needs to be given careful consideration. In today's New York Times, Lawrence K. Altman discusses what the word "pandemic" means to the general public, especially in light of the recent media attention on the swine flu pandemic.

To the average, non-scientist citizen, pandemic is an emotionally charged and scary word. Is this just a question in semantics? Perhaps not. The World Health Organization uses a six-level staging system for declaring a pandemic that informs the actions of countries in such situations.

According to Altman, the word pandemic implies that there is a "rapid spread of an infectious disease to many countries in different regions, hitting each with more or less the same severity". He questions the validity of this implication, saying that the severity of an infectious disease spread varies from region to region, and certainly does not affect every country. The severity is affected by many variables, including the percentages of people dying, a specific population's vulnerabilty to the disease, and quality of health care.

In the past, the WHO posted a definition on their website saying that pandemics led to "enormous numbers of deaths and illness", however, this was recently changed due to the anxiety caused. If one of the missions of public health is communicating accurate risk assessment, scientists and doctors need to be more careful with their words.

Is it the role of the scientist to make her work accessible or for the layperson to stay a reliably informed citizen of the world? Who carries most of the responsibility? For now, I think the word pandemic needs to be more explicitly defined and concrete statistics should always follow its use.

news article link: http://www.nytimes.com/2009/06/09/health/09docs.html?_r=1&scp=1&sq=pandemic&st=cse

Nambian HIV/AIDS Implementor's Meeting

2009-06-09T01:02:00.000-07:00

Hey guys,

So this one is so new and hot that it hasn't even happened yet. On June 10th of this year H.E. Hifikepunye Pohamba, President of the Republic of Namibia, will welcome more than 1,500 HIV/AIDS implementers from around the globe at the opening of the 2009 HIV/AIDS Implementers’ Meeting in Windhoek, Namibia.

The five-day meeting will be hosted by the Government of Namibia, and co-sponsored by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); the Global Fund to Fight AIDS, Tuberculosis and Malaria; The Joint United Nations Program on HIV/AIDS (UNAIDS); UNICEF; the World Bank; the World Health Organization; and the Global Network of People Living with HIV. Namibia was selected to host the 2009 conference in recognition of the country’s leadership in fighting HIV/AIDS.

This year’s conference theme is “Optimizing the Response: Partnerships for Sustainability.” From June 10-14, the meeting will bring together practitioners from around the world to discuss best practices and lessons learned during the implementation of multi-sector HIV/AIDS programs. The program will focus
on boosting the impact of prevention, care and treatment programs; enhancing program quality; promoting coordination among partners; and encouraging innovative responses.
With the goal of building a sustainable response to the pandemic, the meeting will allow implementers to share information that will directly impact their programs in the upcoming year.

The conference is the only meeting of its kind focused specifically on HIV/AIDS program implementation.

Very cool.
Katie
http://www.who.int/hiv/events/implementer2009/en/index.html

GPS phones track swine flu and other diseases

2009-06-09T00:00:00.000-07:00

http://www.techradar.com/news/phone-and-communications/mobile-phones/gps-phones-track-swine-flu-and-other-diseases-606179

The Japanese government and mobile operator Softbank are about to enter the first phase of tests for new mobile phone technology that, incorporating GPS technology, tracks disease carriers. Details for how the test is set-up follows: The first phase will be conducted on 1000 elementary school students. They will be provided phones with the tracking program pre-installedy. A set number of the students will be selected to represented the infected population and monitored as they go about their lives normal, providing researchers a pretty good notion of how many others are potentially exposed to the 'disease.' Ultimately, the program is to provide the user with valuable and up-to-date advice such as when to stay indoors and when to go get a health check. Both mentioned parties behind the program's development are eager for the results, hoping they will confirm their predictions that the technology will prove successful in decreasing the number of contacts a disease makes and preventing massive outbreaks.

Though the government and Softbank tout the programs potentials, criticizing voices are already accusing it of infringing citizens' rights to privacy if implemented in a large-scale manner. They liken the program's monitoring capability with that of Big Brother's in Orwell's 1984. Whether or not this is the case has yet to be seen.

I am greatly interested in the double-edge sword that many emerging medical and biological technology appear to be. Clearly, the potential benefit such technology as the one discussed can bring society is significant. However, at its core, lies another great potential in the other direction, one that conflicts with standard ethics and herein lies our dillemma. I thought about a possible compromise between the population and the government but I realize that the technology would never generate its intended potency unless the entire population participated in it. The only way that the technology could bring its intended benefit without infringing on the population's privacy is it there are clear guidelines drawn up beforehand defining the limits and privileges of the monitoring operators. Otherwise, there's the potential that a lot personal information would be funneled into a few, wrong hands for their personal, exploitative use.

Anyway, this article really falls in love with what marvels me about technology. I think the power and potential that technology can provide humanity can be partially summed up with this quote from Spiderman. "This is my gift, this is my curse."

-Teresa

Mexican genomes show wide diversity

2009-06-08T13:38:00.000-07:00

Mexican genomes show wide diversity

After five years, scientists have mapped the genomes of 300 mestizos, people of mixed Indian and European background, in Mexico. The findings include significant differences between mestizo genetic makeup and those of people with European and Asian ancestry.

Better genetic maps potentially help doctors tailor medicine to the individual. It will be easier to identify genetic risk markers, develop treatments, and prevent diseases including diabetes, hypertension and obesity.

Among the individuals studied, those from northern states were genetically closer to Europeans, while those in southern areas were genetically closer to Native Americans.

Elaine Su

Models’ Projections for Flu Miss Mark by Wide Margin

2009-06-08T13:23:00.000-07:00

Models’ Projections for Flu Miss Mark by Wide Margin

At the height of the swine flu panic in April, two supercomputer teams constructed models the projected a mere 2,500 cases of swine flu in the US by the end of May. The CDC currently predicts that there are over 100,000 cases in the country, despite the fact that fewer than 7,500 have been confirmed.

The two companies have not yet updated their estimates, although other experts suspect that at the height of an epidemic, numbers could double in a matter of days.

The team from Northwestern University attributes the miscalculation to plugging in a number that was far too low at the beginning of the process, as well as the unexpected cases that were brought back to New York from spring breaks in Cancun.

Indiana's team claimed that they were misquoted, or had misunderstood the question when giving their answer, and stated that the first model had predicted 9,500 cases by the end of May.

Experts at this point seem to agree that a sophisticated model is no longer needed, as the flu will likely grow exponentially in the following months.

Elaine Su

Public Health is Not Glamorous

2009-06-06T11:39:00.001-07:00

Nicholas Kristof, a NYTimes reporter known for traveling around the world and covering topics often neglected by other news agents from a very personal level, highlights public health in his most recent Times blog entry. What topic are we worst at covering in the news, he asks? Kristof's answer: public health. Public health, he argues, is unglamorous, and it is long-term, two factors that essentially make it unappealing for news agents and readers alike. Rotavirus is the disease Kristof cites here, a diarrheal disease that kills half a million children annually, and yet one that very, very few have even heard of. An exception would be swine flu and other panic-inciting proto-epidemics, though even the media attention swine flu has received recently seems to have been short lived.

I leave you with two questions. The first is the same one Kristof poses to readers at the end of his article:

1. What other important but unglamorous issues are neglected by the media?

2. What can we do to ensure that issues of public health reach the public? Why is that even important?

http://kristof.blogs.nytimes.com/2009/06/06/what-are-we-worst-at-covering/

Molly

New Malaria Parasite Found in Chimpanzees!

2009-06-06T05:46:00.000-07:00

-C. Paula de los Angeles

Last week, researchers at the Research Institute for Development in Montpellier, France, and the International Center of Medical Research in Franceville, Gabon, discovered a new species of the malaria parasite, and was named Plasmodium gaboni, after closely related Plasmodium falciparum. In order to find this new species, researchers analyzed the blood of 17 chimpanzees, 2 of which had the parasite.

There has been only one other species of malaria parasite resembling Plasmodium falciparum found in primates,Plasmodium reichenowi in apes, so hopefully this new discovery will detail the evolution of malaria in humans and apes, and chimpanzees, their common ancestor.

A major concern of the researchers was the risk of chimpanzee-to-human transmission because of the interaction of chimpanzees and humans in these villages (as pets), as well as the recent jump of a version of the malaria parasite in macaques to humans.

This article brings to light the importance of evolutionary histories of all animals and insects, including parasites. Furthermore, it raises the concern of one of the most dangerous evolutionary adaptations of all, changing hosts. This reminded me of an idea brought up in a lunch we had this weekend with a respect scientist, that it was parasitism that mainly drove evolution. Interesting idea that we can see at work here...

primary article link here: http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000446
news article link here: http://www.nytimes.com/2009/06/02/health/02glob.html?scp=2&sq=malaria&st=cse

Book Review: Rotting Face

2009-06-06T03:27:00.000-07:00

Rotting Face: Smallpox and the American Indian by R.G. Robertson chronicles the story of smallpox in 19th century North America, where it spread through fur-trading networks and devastated the native populations it contacted.

The book has a unique structure. In odd-numbered chapters, Robertson tells the story of the 1837-1838 epidemic in the Americas, which killed vast numbers of Native Americans and altered the power structure of the Great Plains. In even-numbered chapters, he gives readers a global history of smallpox, starting with an overview of its biology and moving on to its initial introduction in the new world.

That structure, like many aspects of Rotting Face, has its ups and downs. In one sense, I appreciated the “background” chapters because I could apply them directly to my understanding of the chapters on the Americas epidemic. In chapter 2, for example, Robertson reviews the symptoms and progression of smallpox; in chapter 3, he describe the first case in his story—in a European fur trader on the upper Missouri river. Having already given us the relevant disease-related background, Robertson is free to stick to his more creative narrative in describing the fur trader. He knows we’ll understand what is going on, and doesn’t have to stop his story to give a more technical description of smallpox’s biology.

But the alternating structure also makes the book feel disjointed; it loses any “flow” it might have had before. Every chapter, I felt like I had to re-orient myself to Robertson’s changing style and purpose. The structure also means that the paired stories, particularly the 1800’s narrative, move painfully slowly—it takes seemingly forever for anyone on the upper Missouri to get smallpox, let alone for the epidemic to start.

Unfortunately, Robertson’s writing, as well as his structure, contributes to the snail’s pace. In an effort to “set the stage” for the reader, he provides minute details on fur-trading life in the Americas, including several excruciating segments on things like steamboat design and coal-shoveling practices. His intentions are noble and occasionally succeeds—the historical setting sometimes helps explain the epidemiology of the disease. But overall, the description (unless you are an 1800’s-Americas-history buff) makes large sections of the book boring. In the middle of long descriptions of steamboat or Native American life, it was almost possible to forget the book’s main topic.

Robertson’s style (maybe due to his attempt to balance technical information with an exciting story), threw me off the most. The book is an awkward mix of flowery description and technical, almost heartless-sounding narrative. Robertson describes Chardon’s Indian wife, whose “long black hair cascaded over her shoulders like waves of glossy silk.” When she dies suddenly in the next few pages, Chardon “[resigned] himself to her death” and “rode across the prairie, searching for a buffalo.” Sometimes Robertson’s descriptions get downright odd. At one point, he gets vaguely Victorian on us: “many a comely damsel has weathered [smallpox] only to forsake the company of men.” At others, they are just perplexing—“above the Missouri floodplain existed an ocean of grass, an expanse so vast the mind struggled to hold it.”

Robertson’s main source on the 1837-1838 epidemic is the diary of a European fur trader named Francis Chardon. It is fantastic that he went back to a primary document for most of his information. The journal appears incredibly detailed, and captures the culture of the fur-trading life as well as the dynamic between European traders and Indian tribes. Europeans were incredibly dependant on Indians for business as well as supplies, and were organized largely around them, with trading agencies and sub-agencies dedicated to the different tribes. However, I wondered about Robertson’s use of a single source for so much of his information. Chardon, of course, had biases, and Robertson doesn’t seem to acknowledge them in his narrative.

Gaps in Chardon’s diaries lead to more unfortunate stylistic decisions. When Robertson wants to describe a particular scene but doesn’t have enough information to do so factually, he uses qualifiers to a distracting extent. “Aboard the steamer, Jacob Halsey and his wife may have conversed with a passenger…or perhaps they accidentally encountered…then again, the Halseys could have…”. It felt like Robertson was trying to bridge an impossible gap between the type of story he wanted to tell, and the facts he actually had.

Robertson (as Molly and other reviewers have pointed out) seems to take an overly critical and even prejudiced attitude towards Native American culture, describing their “shortcomings” in blunt and unthoughtful terms. He describes Indians as having “no understanding of property rights,” living in huts that were “bunched together at random,” and as unable to “fathom a sickness being passed from one person to another any more than they could imagine a warrior with an arrow in his leg transferring the wound to another.” He doesn’t seem to consider the idea that Indians may have a different, non-European conception of property rights, or community organization, or contagious illness. Perhaps Chardon’s diaries had too much of an influence on Robertson’s own perspective?

Ultimately, the unique and sometimes interesting aspects of Robertson’s book—its alternating structure; its use of Chardon’s diaries—come back to haunt the author in its slow-moving style and impossible gaps in the historical record. This book may be a great reference for perspective on the 1838-1838 epidemic, but I don’t think it’s a good cover-to-cover read.

Anne

Modeling the Swine Flu Epidemic: Hyped up or Toned down?

2009-06-05T13:39:00.000-07:00

-C. Paula de los Angeles

In its report on May 15, the CDC estimated that there are upwards of 100,000 cases of swine flu in the U.S., though there are just over 7,000 cases reported. However, these figures are far from conservative estimates of around 2,000 to 2,500 cases from two different leading research groups at Northwestern University and Indiana University made in the last days of April.

So, what happened? Engineering professor Dirk Brockmann of Northwestern blames the mistake on incorrect initial estimates of cases in Mexico that were magnitudes lower than reality, that were applied to a model that is very sensitive to initial conditions. A redeeming trait about Brockmann's model is that he correctly predicted the geographical spread that highlighted California, Texas, Illinois and Florida as "hot spots".

On the other hand, informatics professor Alessandro Vespignani of Indiana University, saying that he was misquoted or misunderstood, and in actually predicted just over 9,000 cases. However, this estimate is still orders of magnitude off.

While both models need refining, Dirk Brockmann states, “For this disease, we won’t put out another projection,” he said. “Once it’s in the dispersal phase, exponential growth kicks in. You don’t need a sophisticated model anymore.”

Another difficulty with refining the model, is that the CDC has decided to stop confirming all swine flu cases in the laboratory. Without good data, modeling is almost impossible.

When Dr. Bob asked us at the beginning of the swine flu scare if we thought it was all hype, I was of the belief, that over-hype is better than no hype. In this case, lack of hype is disconcerting. The extremely conservative estimates give off a false sense of security to the general public and health officials. Models, in general, are difficult for the public to accept, and ones that are as inaccurate as these, do not add any confidence. These conflicting interpretations demonstrate how sensitive models are to a variety of factors. I am hopeful for more reliable data-keeping, better refinement of models, and new interpretations of the models.

News link here: http://www.nytimes.com/2009/06/02/health/02model.html?ref=science

Long time coming: malaria vaccine in phase III clinical trials

2009-06-05T07:18:00.000-07:00

Woohoo...after hearing Dr. Helen McShane's musings on the long road to acceptance for vaccines, it's refreshing to hear a major vaccine inching closer to implementation. GlaxoSmithKline's RTS,S vaccine for malaria has been in development for more than twenty years; a combination vaccine which fuses a protein from the malaria parasite plasmodium falciparum and a surface antigen culled from the hepatitis B vaccine, it is one of the most advanced vaccines in development. And as of last week, it is finally entering phase III clinical trials, which is the final phase of development before the vaccine is sent for regulatory approval.

Tests began on May 26, when five infants in Bagamoyo, Tanzania, ranging from 5 to 17 months of age were inoculated with the RTS,S vaccine. The next few months will see a dramatic expansion to 16,000 children under the age of two in Africa, making it the largest trial of a malaria vaccine candidate ever executed. The hope is that the vaccine will confer lasting immunity to at least half of the children tested. If the trials are successful, the vaccine could be on the market by 2012.

This is a huge development in the fight against malaria, as no completely effective vaccine is available at this point in time. Even a partially effective vaccine would be an appreciated boost to alleviating the suffering caused by malaria across Africa; most of the 1 million under 5 years of age who die each year in Africa died from malaria-related causes. Yet the vaccine is still 3 years away, at least, and there is a lot of hope riding on this one -- it is the only malarial vaccine in development to get to phase III clinical trials. Here's hoping RTS,S delivers on its potential.

article link: http://www.nature.com/news/2009/090527/full/news.2009.517.html

-Andrew Plan

Pluripotent stem cells created...from pigs?!

2009-06-05T06:33:00.000-07:00

Well, here's a fascinating discovery in the already fascinating world of stem cell development, and it might be useful (although admittedly a bit farfetched) down the road for that pesky swine flu that's all the rage. Scientists working in the stem cell lab at the Shanghai Institute of Biochemistry and Cell Biology have successfully induced pluripotent stem cells from the reprogramming of cells in a pig's ear and bone marrow. This is the first report of successful ungulate (animals with hooves) pluripotent stem cells.

The pluripotent stem cells were created with lentiviral vectors that expressed the four genes (Oct4, Sox2, c-Myc, and Klf4) that were used previously by Takahashi and Yamanaka in 2006 to induce pluripotent stem cells from human somatic cells. Subsequent tests confirmed that these cells were indeed stem cells, as they could differentiate into the three cell types that constitute an embryo -- endoderm, mesoderm, and ectoderm.

While the findings are in a very early stage of development, Dr. Xiao, the head of the stem cell lab, remains optimistic about the high potential of these reprogrammed stem cells; he believes that pigs could become donors of organs for human transplantation and their stem cells induced to mimic human disease so as to test therapies without requiring risky human testing. The ungluate pluripotent stem cells could also potentially be used to combat swine flu. If there is a gene that inhibits swine flu activity in pigs, it could be introduced by these stem cells, thus creating a pig resistant to swine flu.

Now I know that we do all sorts of ridiculous things to animals in the name of science, but I can't be the only one disturbed by the implications purported by Dr. Xiao. While his team's breakthrough could be a step forward in alleviating the human organ deficit experienced by hopeful transplant patients, the idea of treating pigs like disposable organ houses seems to me an unsettling precedent for future developments in stem cell technology. Furthermore, such ideas are much farther into the future than I think Dr. Xiao lets on. While pig organs are similar to humans, they are not the same -- there has to be negative health consequences that we cannot possibly forsee without trying out this type of transplant. Stem cell technology in general seems to continually lie at the boundary of medical ethics, so it will be interesting to see how scientists and the general public move forward with developments like these.

article link: http://news.bbc.co.uk/1/hi/health/8078996.stm
link to study: http://jmcb.oxfordjournals.org/cgi/content/full/mjp003v1

-Andrew Plan

DC's Response to AIDS Epidemic

2009-06-05T03:08:00.000-07:00

As Crystal wrote toward the beginning of the quarter, the AIDS rate in Washington, DC is the worst in the country. A staggering report released in mid-March (http://www.washingtonpost.com/wp-dyn/content/article/2009/03/14/AR2009031402176.html) revealed that 3% of residents in the District have HIV or AIDS, a rate that far surpasses the 1% rate that characterizes an epidemic. This prevalence rate is consistently compared to that of West Africa, particularly Uganda and parts of Kenya. The epidemic may even be worse than reported, as infected individuals who had not been tested were not counted; the director of the HIV/AIDS Administration in DC estimates the rate of infection to be closer to 5%. Almost 1 in 10 residents between the ages of 40 and 49 has the disease, and people of all sexes and races are affected. Black men, however, bear the weight of the disease with a 7% prevalence rate. Men having sex with men, injection drug users, and heterosexual transmission are all involved in the spread of the virus.

As a resident of DC, I was astounded by this news and have been watching this spring to see whether and how the city responds to the news. There have been surprisingly few articles since The Washington Post's front-page announcement of the prevalence rate and severity of the epidemic - just one article about increased funding for HIV prevention in the US (no mention of DC), and one about internal feuding in one of DC's AIDS clinics. Finally, this past Tuesday, the Post announced that DC will begin a media campaign to raise awareness about the epidemic in the city (http://www.washingtonpost.com/wp-dyn/content/article/2009/06/01/AR2009060103479.html?sid=ST2009060103553). Mayor Fenty, the article reported, has committed $500,000 annually for five years toward a marketing campaign. Advertising has been shown to raise awareness of HIV, and awareness of transmission and prevention are desperately needed in DC. However, many are critical of the seemingly tame governmental response. Advertising experts, for example, say that Fenty will either need to commit millions more or base the campaign primarily on free public service announcements from television and radio stations, billboards, and the Metro; the costs of advertising are simply far beyond the proposed budget. In my opinion, $500,000 represents far too little commitment for an disease that is the number-one public health challenge in the nation's capital. This being said, DC also faces issues of poverty and a failing school system, and balancing all of these issues is a virtually impossible task.

Regardless of the sum, it is heartening that DC is beginning to respond to the epidemic. In my opinion, now is the time for nation-wide agencies to step in and bolster the city's governmental response. Just 3 days ago, the AIDS Healthcare Foundation, which is the nation's largest AIDS organization, released an ad in DC called "AIDS is DC's Katrina" (see picture). The ad will appear on 60 bus shelters on street corners throughout the District. It shows a picture of a seemingly indifferent and complacent George Bush looking out the window of Air Force One at the devastation of Katrina below, and compares this image to HIV in DC with the phrase "AIDS is DC's Katrina" written on a piece of cardboard and held by two hands. The ad is intentionally provocative and seeks to pressure Obama to take a stronger stand on HIV, especially in DC; it includes the website "changeaidsobama.org". It also criticizes the CDC's leadership in combating HIV in the US. The organization also released an ad with Katrina imagery that will run on YouTube before being broadcast on television; the script of the ad is as follows:

"The aftermath of Hurricane Katrina symbolized George Bush’s neglect and indifference of some of America’s most vulnerable citizens. Today in Washington, the rate of HIV has surged past 3% of the population, higher than in Lagos, Nigeria...yet President Obama has remained silent. 56,000 new U.S. HIV infections each year symbolize neglect and indifference. President Obama, please be the change we can believe in on AIDS."

I certainly believe that Obama needs to take a stand on HIV in DC and in the US, but I also believe that DC must be held accountable for the health of its own citizens. While the new media campaign represents at least a start (I have never, in 4 years of living in DC, seen a single AIDS-related advertisement), more commitment, from the local government and citizens, is needed to draw attention to the epidemic and prevent its further spread.

Cooper

Poxviruses as oncolytic vectors

2009-06-03T21:06:00.000-07:00

Apart from posing a public health threat, poxviruses have gathered research interest for their use as oncolytic vectors. Viral oncolysis takes advantage of the virus’ robust replicative and lethal nature to kill cancer cells. Poxviruses are an ideal choice for viral oncolytic agents. Replication and host cell lysis occurs relatively quickly; the first viral particles are secreted within 8 hours and infected cells are destroyed 2 to 3 days after infection. Poxvirus cell-tropism is broad and can enter multiple cell types, and the EEV form spreads quickly through the bloodstream to distant tumors. Poxvirus genomes do not integrate into the host cell chromosome, and thus there is no concern of inducing potentially dangerous gene disruptions. Of particular importance for genetic engineering, vaccinia can accommodate multiple large transgenes to enhance oncolytic function . Finally, in case of an adverse response, many antiviral agents are available to treat poxvirus infections.

Poxviruses naturally selectively replicate within cancer cells, but engineering can enhance that specificity. The activities of cancer cells (blocking apoptosis, deregulating the cell cycle, and evading the immune system) are also characteristic of viruses and provide an optimal condition for poxvirus replication. Engineered viruses missing genes regulating these functions will replicate in cancer cells but not normal cells. In addition, deletion of these genes reduces the virulence of the virus towards normal cells. For example, vaccinia replication relies on the activation of the EFGR – Ras signaling pathway; a vaccinia strain engineered with a defective EFGR-Ras signaling pathway will selectively replicate in most cancer cells, where EFGR-Ras pathway is activated, but not in normal cells. Once established within a tumor cell, poxviruses induce cell-death in multiple ways. First, poxviruses kill cancer cells directly by infection, leading to cell lysis and death (both apoptosis and necrosis). Poxvirus infection also elicits immune responses, which induces an adaptive immune response to the tumor. Finally, vaccinia infection of tumor-associated endothelial cells results in vascular collapse (Kim, 2009).
There are many transgenes that can be inserted into engineered oncolytic vaccinia. These transgenes must be carefully selected, because a transgene secreted during cell death could elicit bystander effects in surrounding non-infected cells. In addition, it is necessary to ensure that the gene products do not have direct antiviral effects and do not clear the viral vector before it destroys the tumor. Transgene products include cytokines and other factors that enhance immunogenicity, and agents that improve viral spread within the tumor by disrupting the extracellular matrix.

Transgenes can also enhance the “stealth” of poxviruses to evade premature removal by the host immune system by coating the virus with cationic liposomes or polymers, or by increasing production of the EEV form, which is capable of evading complement and antibodies due to its additional envelope. Apart from oncolytic properties, transgenes can also be used for imaging purposes. For example, expression of genes such as luciferase or those encoding fluorescent proteins can be used to determine tumor sites and size. Several promising poxvirus oncolytic vectors are currently undergoing clinical trials. JX-594, the first strain of vaccinia to be used clinically transgenically expresses granulocyte macrophage colony stimulating factor (GM-CSF) to enhance tumor cell death via immune-stimulation. However, several hurdles remain to oncolytic viral application, including balancing benefits and drawbacks of the host immune response and possible transmission through viral shedding to the environment.

I was drawn to this article because of Khang’s recent presentation on viral vector therapy. I like this research because, unlike other research on smallpox, it seems like something that we can actually use. Vaccine and antiviral research seems to me a bit unproductive; why not redirect that energy and resources to research on a pathogen that actually still poses a real threat? Additionally, I’m not sure how much of the bioterror threat is real, and it seems that preservation of smallpox strains in the name of research poses a big bioterror threat itself (who is to say that the US or Russia are not engaging in bioweapons research?). It also gives me a greater appreciation for bioengineering for their smart ability to manipulate nature to our needs. For example, I never realized how similar cancer cells and viral particles are in function. Oncolytic therapy seems to me like a smart way to take advantage of smallpox virulence and apply it in a therapeutic way, shedding some good on this historical scourge of humanity.

Kirn & Thorne (2009) Targeted and armed oncolytic poxvirus: a novel multi-mechanistic therapeutic class for cancer. Nature Reviews Cancer, 9:64-71.

Crystal

Fears of Vaccine Increase Whooping Cough Risk

2009-06-02T14:16:00.001-07:00

-C. Paula de los Angeles

A recent study by Dr. Jason Glanz of the Kaiser Permanente Institute for Health Research in Colorado published in Pediatrics found that the vaccination for the whooping cough is highly effective--in fact, children vaccinated against the whooping cough are twenty times less likely to catch this contagious disease than children who are not vaccinated. The whooping cough is characterized as uncontrollable deep coughing, claiming infants as its most susceptible and vulnerable victim.

As an epidemiologist, Glanz found that one in twenty-five children not vaccinated got the whooping cough, whereas only one in five hundred children who were vaccinated. The study is the first to look at the relationship of immunizations and rats of whooping cough (pertussis) through medical records. Glanz says he wanted to examine the influence of vaccine refusals with the whooping cough because the illness is still very much present, with 10,000 US cases in 2007.

Glanz argues that many factors may be deterring parents from vaccinating their children, namely the empty threat of Autism as well as the belief in "herd immunity", the idea that if others vaccinate their children, vaccinating one's own children is unnecessary. He believes that the "tipping point" to an outbreak would be if immunization rates drop below 90%.

An interesting issue this article highlights is the idea of herd immunity. In an economic sense, it seems like all lose if someone doesn't vaccinate (prisoner's dilemma). Because we can never be sure if the other person will vaccinate on their own, is it necessary that we make all rigorously approved vaccines mandatory? Perhaps, I think.

Primary article here: http://pediatrics.aappublications.org/cgi/content/full/123/6/1446?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=jason+glanz&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

The cost and impact of male circumcision on HIV/AIDS in Botswana

2009-06-02T14:09:00.000-07:00

The estimated HIV prevalence in Botswana is currently an overwhelming 25.7 percent. The Ministry of Health recently added the promotion of male circumcision to its HIV prevention strategy as three randomized controlled trials in South Africa, Uganda, and Kenya found that HIV transmission from females to males was reduced by up to 60% when males were circumcised.

This study examined the cost and effect of scaling up male circumcision which is currently listed as a strategy to harnessing the spread of HIV in the UNAIDS/WHO Decision-Makers' Program Planning Tool. The researchers ran different scenarios to measures the cost and impact. They found that scaling-up both adult and neonatal male circumcision to reach 80% coverage by 2012 would result in the prevention of almost 70,000 new HIV infections through 2025. The price for such a strategy which would be $47 million meaning an average of $689 would be spent per HIV infection. When they changed the target date to 2015, they found that they could avert approximately 60,000 new HIV infections through 2025. From 2008 to 2015, 27.3 male circumcisions would be required to avert one HIV infection. This number would decrease to 7.3 circumcisions from 2016 to 2025 because of the increasing impact of circumcision over time.

The authors of the study say that "scaling up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly." While male circumcision does have potential, there are a lot of things that need to be considered before scaling up male circumcision. The first is that is it safe? Can the male circumcisions be performed with sterile tools by people who have trained to do so? Secondly, I think there is a danger in treating male circumcision like condoms; male circumcision does not necessarily guarantee protection from HIV every time a man has sex (well neither do condoms, but I think you get my gist...). Also, do you think it's a good use of $47 million, and how does one go about encouraging thousands of men to be circumcised when it is not a part of their culture? There are a lot of things to be considered, but I still think that studies like these are important because they offer the numbers that often serve as the stimuli for the development of policy.

For the full article: http://www.jiasociety.org/content/pdf/1758-2652-12-7.pdf

-Elizabeth

Avian Flu

2009-06-02T01:16:00.000-07:00

Here are a few cites which track Avian flu. They are all from the WHO website. The first is a graph which shows both cases and deaths from 2003 to 2009 in 16 different countries. It is a great snapshot of the outbreak and demonstrates how deadly avian flu is ( total cases: 432, total deaths: 262) One of the interesting things is that the death rate is not consistent across country lines, with Indonesia's at about 81% and Viet Nam's at 50%. Overall the death rate is closer to that of Viet Nam.

The second is the latest update on avian flu. A baby girl from Edgypt came down with Avian flu on May 25th and was admited ot a hospital on the 29th. She is now in stable condition. Investigators confirmed that she had contact with sick dead poultry prior to infection.

http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_06_01/en/index.html

http://www.who.int/csr/don/2009_06_01/en/index.html

Katie Ridley

Book Review: "Rotting Face"

2009-06-01T14:15:00.000-07:00

The title of R. G. Robertson’s “Rotting Face” is immediately intriguing, the term being the name used by American Indian tribes of the Upper Missouri for the disease of smallpox, which ravaged the area in the mid-19th century. The book details the disease’s introduction to the tribes of the Upper Missouri region, extending north from St. Louis into Canada, on as personal a level as possible. Clearly using a few key primary sources, such as Francis Chardon’s personal diary, Robertson carefully notes names, dates, and places in an effort to be historically accurate. In addition, Robertson alternates this narrative of the introduction of smallpox with chapters detailing a plethora of related topics, such as the history of the region’s fur trade, American Indian commercial practices, and the history and clinical features of smallpox itself.

Unfortunately, this minute attention to detail in the narrative combined with the alternating chapter structure means that the book moves incredibly slowly. Though I feel as though I now have a firm understanding of the process of shoveling coal into various types of steamboats in order to fuel their long journeys upstream, the process of obtaining this information was at times tedious, and more attention to smallpox than fur trading may have helped to focus Robertson’s expository. Repetition of a few key grammatical errors also hindered the narrative’s flow.

Another point I found troubling within Robertson’s prose was a tendency to use phrases that, while likely intended to make the text exciting, succeeded also in sounding pejorative toward many of the Indian tribes in question. For example, Robertson is wholly dismissive of any Indian attempts to treat the disease, recounting the activities of shamans with an almost playful tone. The sentence, “Having no understanding of property rights, Native Americans signed countless treaties, thinking they were licensing the English to work their land while maintaining their own claim of usage” fails to note that while the Indians may have had little understanding of the European property rights claimed by white settlers, tribes did in fact have systems of land distribution of their own.

In total, the book does record the outbreak of smallpox primarily in the Mandan, Hidatsa, and Arickara tribes, a subject that seems to have attracted little scholarship so far. Additionally, Robertson tackles his subject from an interesting angle in his exploration of fur trading culture, so that readers are left with an understanding of the economic-cultural system as a whole, rather than of a few individual components. With the hard work of a stringent editor, this book could become incredibly important on the scene of academic literature on smallpox and the American Indians in the 19th century.

-Molly

A Possible Faster and Cheaper Way to Detect Viruses

2009-06-01T13:09:00.000-07:00

Researchers at USC have developed a faster and potentially cheaper way to detect very small protein particles, such as the proteins found on the surface membranes of viruses. The new system employs engineered antibodies attached to a nanowire which is in turn connected to an electrically responsive base. The binding of the antibody to its specific ligand induces an electrical current which is easily registered. This work marks an important advancement in nanowire biosensor technology; one of the key advancements is the use of indium oxide, an exotic metal oxide which unlike silicon oxides, which was used in previous designs, does suffer from degradation in sensitivity.

In particular, the prototype was designed to detect the n-protein on the SARS virus. In tests, the nanosensor performed at least as well in sensitivity and specificity as the best available method currently- enzyme-like immunosorbent assay (ELISA). The advantage however, is that nanosensors take approximately 10 minutes for a reliable result whereas ELISA would require hours. Furthermore, nanosensors have the potential of being cheaply scaled.

Cheers,
Khang

Source:

Green Tea Fights Infection?

2009-06-01T03:36:00.000-07:00

In findings presented to the 109th General Meeting of the American Society for Microbiology May 17-21, 2009, Dr. Megan Meyer found that doses of green tea helped cells significantly in their ability to fight Staphylococcus aureus infection, specifically in the microbicidal capabilities of macrophages.

The researchers formed their hypothesis after noting earlier findings that green tea may help inhibit the growth of bacteria and anthrax lethal factor and "[modulate] the production of reactive oxygen species by the immune system."

In conducting the experiment, Dr. Meyer and her team first subjected green tea to a process designed to mimic the effects of human digestion, then subjected RAW 264.7 cells to this material for 24 hours. They then exposed the cells to the Staph bacteria and studied how well the cells were able to fight infection.

At the end of the test period, cells with even the lowest concentration of green tea (the equivalent of one green tea pill daily--and I thought green tea was something you drink!) recorded a 32% reduction in the amount of surviving Staph bacteria as compared to non-green tea-exposed control cells. A concentration equivalent to two green tea pills daily recorded a 38% reduction in surviving Staph. Researchers suggest that these results occur because of the green tea and its polyphenols' effects on the "oxidative potential of the cells and through modulation of cytokine synthesis and secretion."

Although I wholly doubt that overdosing daily on green tea is all that beneficial, it seems that even small doses of green tea can have potentially exciting effects in helping boost the immune system in helping macrophages kill bacteria. "Some green tea each day keeps the doctor away"??

http://www.infectiousdiseasenews.com/article/40178.aspx

Molly

Lowering the age of the MMR vaccine in the UK

2009-06-01T02:10:00.001-07:00

"Baby Measles Immune Boost Call"

With measles cases rates up by 36% in England and Wales, there is currently a call for an earlier MMR booster to be given to newborns. Appropriate herd immunity for measles is somewhere around 95%, and after the first and second MMR boosters in the UK, herd immunity levels were only at 85%. Measles is especially dangerous and can cause severe complications in very young babies, especially today- newborns used to gain temporary protection from antibodies passed from their mothers in the late stages of pregnancy, but because mohters now "have vaccine-mediated immunity rather than natural immunity against measles, that protection in babies is less than it was.". Because of this change in immunity status for newborns, there is a call for an immune booster shot for any baby that has been in recent contact with any measles-infected person.

With the rates of unvaccinated children growing because of either unfounded concerns about risks of autism, or religious sanctions, a public health risk is being presented to the whole population. This article is just one of the many trumpeting an increase in vaccination procedures, and with newborns put at risk by this lack of prevention efforts, perhaps this will get the ball moving.

Enjoy!

http://news.bbc.co.uk/1/hi/health/8074377.stm

Kaitlyn

British scientists ask WHO to condemn homeopathy for diseases such as HIV

2009-06-01T01:57:00.000-07:00

http://www.guardian.co.uk/science/2009/jun/01/world-health-organisation-homeopathy-hiv

British scientists question the effectiveness of homeopathic treatment for serious diseases such as HIV, TB, and malaria and are demanding that the WHO rid its use of it. Not only do they believe the treatment is ineffective, but they also fear that it is causing avoidable deaths as patients choose homeopathic treatment instead of effective medicines.

WHO currently works with many local organizations in Asia and Africa that provide homeopathic treatment through their respective areas. Homeopathic treatment refers to the treatment that involves diluting a concentrated sample of a disease with water until there are not traces left of the original compound and dispensing that to patients for ingestion. It is a very cheap method that reports few cases of bad side effects. However, the british scientists, along a significant number of those in the medical community, now claim that homeopathic treatments are fully ineffective and are only placebos.

The british scientists bring up social issues with their demand, ultimately asserting that continual support of homeopathic treatment is an exploitive gesture. They claim that those in the impoverished regions of Africa and Asia deserve effective treatment just like everyone else and distribution of homeopathic treatment exploits their poor social status. There's very little evidence proving the potency of homeopathic treatment and thus, WHO should make a conscious effort to provide more proven medical treatments to the regions.

One event the british scientists bring up in support of their argument that homeopathic treatments are ineffective and dangerous is the one that occurred under Thabo Mbeki's policies in South Africa that reportedly lead to 365,000 unnecessary deaths.

It intrigues me that the WHO still promotes homeopathic treatment through the selection of the organizations they support. I wonder what their reason behind it is, considering that in my nations, there are no laws governing homeopathic treatment and thus there is significant potential of abuse on the physician's or administrator's part. I wonder why the WHO, who is suppose to be the world's health defender, would still cling to practices that most medical experts claim are outdates, ineffective, and downright lethal. Are they aware they are potentially cutting corners? Like what I reported a few weeks ago, is there racism or class discrimination at play here? Or maybe the cultures they're administering the treatment to prefer homeopathic medicines? However, just because they prefer it doesn't mean it's okay to settle on sub-par treatment for them. If the WHO is really an equal opportunity type of organization, then shouldn't the level of treatment be the same for all patients? Especially since my tutorial closely examines the interplay of politics and semi-political international welfare institutes, news like this really interests because they suggest that goodwill, despite their public presentation, often is not the primary motivation for the institutions actions.

-Teresa

‘Underlying Conditions’ May Add to Flu Worries

2009-05-31T16:15:00.000-07:00

‘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

2009-05-31T14:52:00.000-07:00

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?

2009-05-31T14:23:00.000-07:00

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.

Anne

Book Review: Demon in the Freezer

2009-05-31T02:50:00.000-07:00

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.

Anne

Why we love smallpox?

2009-05-29T13:58:00.000-07:00

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.

Anne

Vaccine-autism controversy alive and well

2009-05-28T01:00:00.000-07:00

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: http://www.sciencedaily.com/releases/2009/05/090526202720.htm
PLoS report link: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1000114

New and hot: Transgenic monkeys

2009-05-27T18:40:00.000-07:00

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:

http://www.watoday.com.au/world/science/the-green-monkeys-are-coming-20090527-bnk7.html

http://www.google.com/hostednews/ap/article/ALeqM5j6OwFtAW3J9gAlJCdwI_AXswhkWgD98EPG5O0

http://www.redorbit.com/news/health/1695679/scientists_create_first_transgenic_monkeys/

-Andrew Beck

Buckyballs as potential inhibitors of HIV

2009-05-26T11:46:00.000-07:00

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: http://www.sciencedaily.com/releases/2009/05/090519134839.htm

-Elizabeth

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

New and Hot: HPV Vaccination in Men?

2009-05-26T09:54:00.000-07:00

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

2009-05-26T06:31:00.000-07:00

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,

-Anne

Millennium Development Goals Report

2009-05-26T03:20:00.000-07:00

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.
http://www.who.int/mediacentre/news/notes/2009/millennium_development_goals_20090521/en/index.html

Katie Ridley

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

2009-05-25T22:05:00.000-07:00

-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: http://www.nytimes.com/2009/05/25/world/middleeast/25oink.html?scp=1&sq=infectious%20disease&st=cse

Smallpox Vaccine and Eczema

2009-05-25T13:59:00.000-07:00

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 (http://www.sciencemag.org/cgi/content/full/316/5830/1418).

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: http://www.sciencedaily.com/releases/2009/05/090525105433.htm

Cooper

W.H.O. to Rewrite Its Pandemic Rules

2009-05-25T13:06:00.000-07:00

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

2009-05-25T12:50:00.000-07:00

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

2009-05-25T10:33:00.000-07:00

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.

Cheers,
Khang

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

Blog of the Artist who did the Attic in Jenner Museum

2009-05-25T07:17:00.001-07:00

http://www.a-n.co.uk/artists_talking/projects/single/520666

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.

-Teresa

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

2009-05-25T06:59:00.001-07:00

http://english.rti.org.tw/Content/GetSingleNews.aspx?ContentID=79338
http://www.etaiwannews.com/etn/news_content.php?id=958077&lang=eng_news
http://www.taipeitimes.com/News/front/archives/2009/05/25/2003444491
http://www.etaiwannews.com/etn/news_content.php?id=958582&lang=eng_news

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.

-Teresa

Industry's influence on medical research

2009-05-25T04:28:00.000-07:00

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.

Anne

Book Review: Speckled Monster

2009-05-24T16:53:00.000-07:00

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).

Crystal

Sex traffickers threaten women with smallpox

2009-05-23T10:19:00.000-07:00

http://www.nytimes.com/2009/05/23/world/europe/23spain.html?emc=tnt&tntemail0=y

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.

-Crystal

Book Review: Pox Americana by Elizabeth Fenn

2009-05-22T17:04:00.000-07:00

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

Book Review: The Speckled Monster by Jennifer Carrell

2009-05-21T06:27:00.000-07:00

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

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

2009-05-20T20:35:00.000-07:00

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.

http://online.wsj.com/article/SB10001424052970203771904574177701770654102.html

-Andrew Beck

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

2009-05-20T17:58:00.000-07:00

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: http://www.sciencedaily.com/releases/2009/05/090519104116.htm

-Andrew Plan

A promising new malaria treatment...

2009-05-20T17:15:00.001-07:00

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: http://www.sciencedaily.com/releases/2009/05/090518134144.htm

-Andrew Plan

How Down syndrome works against cancer

2009-05-20T14:30:00.000-07:00

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: http://www.nature.com/nature/journal/vaop/ncurrent/pdf/nature08062.pdf

-Elizabeth

Avian Flu outbreak in China

2009-05-19T10:52:00.000-07:00

http://news.xinhuanet.com/english/2009-05/19/content_11401331.htm

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.

Crystal

Ghosts in the Jenner House!

2009-05-19T10:39:00.001-07:00

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?

Crystal

http://news.bbc.co.uk/1/hi/england/gloucestershire/8055735.stm

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

2009-05-18T19:59:00.000-07:00

-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: http://www.naturalnews.com/026293.html

Brain Cancer Vaccine?

2009-05-18T19:48:00.000-07:00

-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: http://wcbstv.com/topstories/brain.cancer.vaccine.2.1012685.html

New n' Hot: Cell Exhaustion in Chronic Viral Infections

2009-05-18T18:25:00.000-07:00

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:
http://www.sciencedaily.com/releases/2009/05/090513173459.htm

-Molly

HIV and ARV Treatment

2009-05-18T18:03:00.000-07:00

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.

Cooper

Rise in Biodefense labs Upsets Residents

2009-05-18T16:22:00.001-07:00

-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: http://www.globalsecuritynewswire.org/gsn/nw_20090518_3524.php

Childhood: Order of Vaccinations Helps With Pain

2009-05-18T05:46:00.000-07:00

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

2009-05-18T05:16:00.001-07:00

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?

2009-05-18T05:10:00.000-07:00

"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.

http://www.infectiousdiseasenews.com/article/38935.aspx

Enjoy!
Kaitlyn

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

2009-05-18T02:58:00.000-07:00

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.

Cheers,
Khang

Source: http://www.sciencemag.org/cgi/content/abstract/1176062v2

Happy Birthday Jenner!

2009-05-17T17:55:00.001-07:00

It's Jenner's Birthday: May 17

http://www.findingdulcinea.com/features/profiles/j/edward-jenner.html

-C. Paula de los Angeles

A new CDC director!

2009-05-17T15:49:00.000-07:00

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!

-Elizabeth

Inoculation brought over from Africa

2009-05-17T13:07:00.000-07:00

http://www.telegram.com/article/20090514/COLUMN21/905140539

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.

-Teresa

Revolutionizing disease classification?

2009-05-17T12:37:00.000-07:00

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!

Anne

DNDi makes new drugs for sleeping sickness

2009-05-17T10:44:00.000-07:00

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.

Anne

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

2009-05-17T04:05:00.000-07:00

Mar 27 2009
http://www.hivandhepatitis.com/recent/2009/032709_b.html
http://huserlab.ucdavis.edu/HIV-movies.html
http://www.sciencemag.org/cgi/content/abstract/323/5922/1743

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:
http://www.youtube.com/watch?v=F8wf0zpo6Rs
http://www.youtube.com/watch?v=jzPKiFToItA

Elaine C

New and Hot: Virus Causes High Blood Pressure

2009-05-15T13:23:00.000-07:00

May 14 2009
http://www.sciencedaily.com/releases/2009/05/090514221915.htm

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