Review

 Some suggestions for reviewing the class from previous TAs.

Diseases

o   Biology of disease, symptoms, pathogenesis, reproduction, etc.?

o   What kind of organism causes it?

o   How is it transmitted? (direct, waterborne, vector, what vector?)

o   Can we treat this disease, how? Is it curable? Preventable?

o   How does this disease affect humans?  What kind of host are we for it?

o   How does ecology of host affect transmission, what happens when this ecology changes?

Definitions

o   Use the Glossary to review the terms covered and their definitions.

o   You are responsible for all terms in the glossary that we covered in class, (I took a quick look and the only terms I see that we didn't cover this year are Endogenous retrovirus and retrovirus, plus Hantavirus cardiopulmonary syndrome and Hantavirus 'sin nombre'.

o   Think about the context in which we learned each term: what disease were we studying? What concepts in epidemiology or ecology were we discussing? What other diseases does the term relate to?

Concepts/Themes

o   Review how diseases relate to the theme of the week in which they were covered.  Do any diseases relate to themes covered in other weeks, how so?

o   Refer back to the Short Answer section of the Midterm and the quizzes to review concepts.  

o   Are there any diagrams used in lecture or reading which demonstrate and relate concepts?

Timeline

o   Create a timeline to review when disease outbreaks and scientific discoveries happened, and when people were doing their work.  More than specific dates, focus on reviewing the context in which events/people were working, and when they were working relative to other’s work and other historical events.

Final

No essential information here but since I know people check in here before the exam here's something for you

The final will be a very similar format to the midterm. It will have:
20 Multiple choice questions worth 1 point each.
6 Presidential briefing document questions worth 2 points each (both have two words or phrases underlined that you need to provide a simple and clear definition of).
6 More general questions that the President has for you. These may not have a single correct answer.

This adds up to 44 points. I was going to give you a point for free but then realized I may as well collect some data. My first instinct was to have a question asking which President you imagined because I'm actually curious. Then I worried this would appear like I was interested in your political leanings - I'm not, I'm just curious which President the younger generation pictures when asked to imagine 'a President'. So the free question will ask:
Is there an infectious disease you would have liked to have seen covered in this class that we did not cover? 
Writing anything (even, 'no') will get you a point. I'm putting it here because you might want to think about this ahead of time. If there are a significant number of people who'd like to know about West Nile virus, Dengue Fever, Hepatitis, or Chlamydia for example I can make sure I fit them into the class in the future.

TED talk

I came across this video of Laurie Garrett, the author of the Coming Plague, speaking at a small TED event in 2007. This was before the H1N1 swine flu of 2009 and so she is mainly talking about H5N1 avian flu. I think she makes a lot of very interesting points and the talk acts as a great review, not just for the final week but also for other topics we covered.

Procrastinate and review

If you want to review some topics from the class in a painless and social way then why not get together with some friends to watch and discuss Steven Soderbergh's movie Contagion that came out in Fall 2011? (I just checked and it isn't on Netflix on demand but it is on Amazon instant video for $1.99 for a 48 hour rental).

As a movie I think it is decent, but not great, but what is interesting is that it takes its science very seriously. So much so that at least two science outlets wrote reviews praising the movie for this. Whether it is the origin of the virus, the importance of R0, how vaccines are made (and the difference between live, attenuated and dead vaccines), or the importance of fomites the film gets it right.

Contagion doesn't skimp on science at New Scientist
Soderbergh and screenwriter Scott Burns practice what is in effect very successful science communication: they keep the viewer's attention as they explain statistics like the all-important R0 - the average number of people an infected person infects - and truths about the scientific process, such as the fact that before researchers can study a virus, they need to figure out how to grow it in cell cultures in the lab, without the virus destroying all the cells.
  
Contagion, the Movie: An Expert Medical Review at Medscape
The moviemakers did a very good job of illustrating how Southeast Asia can essentially serve as a "genetic reassortment laboratory" with influenza strains being created as a combination event among strains from pigs and chickens (and in this case, bats) to create a strain that the population has never seen before. They do a very good job of explaining that possibility and in showing how easy the virus can spread from one person to another. In fact, in bringing up the concept of contagiousness as "R0," they compare the R0 of influenza, polio, and smallpox. It's very interesting that they were willing to spend time explaining what contagiousness means.

Swine flu (and conspiracy theories)

I just watched a whole bunch of videos about swine flu to see if there was a nice simple summary I could post here. It's amazing some of the crazy stuff that is out there. Not only is there a whole Swine flu conspiracy theory but its wrapped up with chemtrails, the new world order and probably Lee Harvey Oswald if you watch further than I did. You can get all your conspiracy theories covered in one go in this video which takes a look at some of them.

The video above is a nice simple illustration of where Swine Flu came from and reviews some of the topics we covered in class. It also simply explains why we might expect more contagious strains of flu to be less dangerous - it's all down to which part of the respiratory tract they infect.

To publish or not?

Some of you may have read about an interesting disease related debate that is going on right now and is attracting quite a lot of media attention. It concerns the H5N1 strain of influenza that appears to have a high mortality rate in people but is currently poorly transmitted between people (if it is even transmitted at all).

In 2011 two teams of scientists created mutant strains of H5N1 influenza (ie avian or bird flu) that could be more easily passed between mammals in a laboratory setting (ferrets are the animals of choice for flu studies apparently). Scientifically this is interesting research and could address several public health issues: can this strain become more easily transmitted without losing its virulence? Which changes should we watch out for? How many mutations does such a change require?

However as the papers were reviewed the US National Science Advisory Board for Biosecurity (NSABB) recommended that the results of the two studies should only be published in a redacted form. They advised that methods and details should be left out for fear the research could fall into the wrong hands and be used to create a pandemic that might kill tens of millions of people. This unprecedented move sparked a broader debate about censorship and responsibility in potentially dangerous research.

It also provoked some sensational headlines:
Controversial 'Armageddon' super virus recipe to stay secret - for now - Sydney Morning Herald

In a meeting last month the World Health organization came to a different conclusion. A panel of 22 experts  concluded that the mutant flu studies should be published in full. They argued that redaction would likely be ineffective and that the benefits outweighed the potential risks.

Nature have put together a web special on the H5N1 controversy that compiles a variety of papers, reports and commentary (and is also the source for this fantastic chicken image).

Vaccination then and now

As I mentioned in an earlier class vaccines become victims of their own success. As the diseases they cause become rare and fade from our memory we tend to focus on the possible side effects of the vaccine - sometimes real, sometimes imagined.

However when the actual disease in in your neighborhood, crippling and paralyzing children then you queue around the block to get your child their vaccination shot.

One fact I didn't mention in lecture was that neither Jonas Salk nor Albert Sabin (who invented the oral polio vaccine) patented their vaccines - they donated the rights as gifts to humanity. In fact there's a fairly famous story about Jonas Salk, who worked at the University of Pittsburgh, being asked by a reporter “Who owns your polio vaccine?” On hearing the question, Dr. Salk looked at the reporter and said “Who owns my polio vaccine? The people! Could you patent the sun?”