Thank You

A big thank you to everyone who posted to the blog this quarter. It was a happening place with multiple posts most days. It's surprising how, even though we cover a lot of historical topics, the subjects we cover are in the news.

• From the possibility of eradicating AIDS to Antibiotic resistance and MRSA.
• From the Pope rejecting condoms to the President acting to prevent sick cows entering the cow foodstream.
• From pathogens in our pork to bubonic plague in our ferrets.
• From squirrel brains to zombie snails.

If you enjoyed the class please tell your friends (I don't get paid by the student, I just honestly believe people should know this stuff). The class will run each Winter quarter AND in summer session.

If you did not enjoy the class, or it wasn't what you expected, or you have suggestions for improvement then please let me know if you haven't already.

Good luck on your finals and have a safe spring break.

John

AIDS in South Africa

After graduating high school, my friend Melissa left for almost a year to South Africa, where she visited children and families, helped in hospitals, set up activities, distributed Adopt-A-Bears, and so much more. I knew she was blogging her experiences, so I asked her if she had any stories of encounters with AIDS that I could share on this blog. It really makes what we are learning in the classroom come alive.

"I met ThuThukani at our small camp for orphans and other vulnerable children from Burlington- a slum community in South Africa. Whenever I saw ThuThukani, he seemed to have just one look on his face; a look that said things like, “I don’t want to be here,” or “I hate my life.” He would often sit alone, silent, never uttering a word to anyone. Despite the calming efforts of teachers, other children, or my fellow teammates, ThuThukani was angry and aggressive. If the other children were coloring, he would refuse to color until people stopped asking him to. Then, as soon as the adult left him to himself, he would slowly reach for a crayon and begin softly scribbling onto a sheet of paper. He was quiet. He was defiant. But he was constant. Anyone could tell just by looking at him that he had his own way of doing things. But what anyone observing him could not tell just by looking was that ThuThukani was dying of stage four AIDS.

In Africa, no one is too shy to term this “full-blown.” His immune system was next to nothing, and he was only twelve years old. Suddenly, all in the split second of hearing these words, ThuThukani made complete sense to me. I found myself understanding his blank stares into space while trying to look him straight in the eye and rebuke his behavior. I understood his refusal to do as he was told. Because he just didn’t see the point. At a young age, ThuThukani had to come to terms with the fact that his life would be short. A virus which was given to him during childbirth would bring the end to his life, almost before it had even begun. In his silence, defiance, and in that little face of his, he had to understand all of this. And so, I learned to understand ThuThukani.

I could not wrap my mind around AIDS ripping apart Africa. But as much as I could not understand, what I could understand was this boy. I could see his pain and frustration. Putting a face to those grim four letters, AIDS, made it all too personal to me."

Pope claims condoms could make African Aids crisis worse

The pontiff said condoms were not the answer to the continent's fight against HIV and Aids and could make the problem worse.

While in Africa, the pontiff is expected to talk to young people about the Aids epidemic and explain to them why the Catholic Church recommends sexual abstinence as the best way to prevent the spread of the disease.

The Pope is entitled to his opinion on the ethics of condom use however I do not believe he is entitled to make inaccurate statements about the efficacy of abstinence programs versus condom use. Since I don't believe the Pope is likely to read this I'm not going to go to go into too much detail but you may remember this study from a couple of years back:

Sex abstinence programmes do not stop risky sexual behaviour or help in the prevention of unwanted pregnancy, a research team has concluded. The Oxford University team reviewed 13 US trials involving over 15,000 people aged 10 to 21. They found abstinence programmes had no negative or positive impact on the rates of sex infections or unprotected sex, the British Medical Journal said.

Is Life a Sexually Transmitted Disease?

I got into a debate with a friend involving life as a sexually transmitted disease. According to MedTerms (www.medterms.com), a sexually transmitted infection is “an infection that can be transferred from one person to another through sexual contact. In this context, sexual contact is more than just sexual intercourse (vaginal and anal) and also includes kissing, oral-genital contact, and the use of sexual "toys," such as vibrators.” I argued that human life is not “transferred from one person to another” but rather created via fertilization. I also pointed out that there are several organisms (life forms) are asexual and do not sexually reproduce. It was an interesting topic and varies depending on everyone’s definition of life and disease.

Anyway, I thought this shirt was hilarious, even though I do not agree with it.

Prion Trio

Three prion related research stories that have come out lately:

1/ Regulation of Embryonic Cell Adhesion by the Prion Protein in PLoS Biology this week.

Researchers in Germany have shown that the regular Prion protein (the one everyone has, that isn't infectious and doesn't cause problems) plays a beneficial role for the organism by helping cells communicate with one another during embryonic development. Even though we have known that a normal prion protein in the brain can turn harmful and cause deadly illnesses like Creutzfeldt-Jakob disease (CJD) in humans, and bovine spongiform encephalopathy (BSE) in cattle we did not, until this paper, know why large amounts of this normal protein are produced by our bodies in the first place.

2/ Cellular prion protein mediates impairment of synaptic plasticity by amyloid-beta oligomers in Nature a couple of weeks ago.

The regular prion protein may contribute to nerve damage if it becomes entangled with a protein fragment that scientists consider a chief suspect as a cause for Alzheimer's disease. The prion protein, if it is involved in Alzheimer's, is probably in its normal form. There's no evidence that the disease somehow releases infectious prions.

3/ Safety and efficacy of quinacrine in human prion disease (PRION-1 study): a patient preference trial in the April issue of Lancet Neurology.

The anti-malaria drug quinacrine does not appear to extend the lives of people with the human form of mad cow disease, despite encouraging results from experiments with mice. Currently there are no drugs that prevent or reverse the disease, though quinacrine has shown promise in treating prion-infected mouse cells because it can penetrate the blood-brain barrier and the drug has been effective in treating these prion-infected mouse cells by blocking the conversion of normal proteins into the abnormal disease-causing form.

Answers to quiz 4

1. The parasite that causes malaria, Plasmodium falciparum, is most closely related to Toxoplasma gondii. Both parasites are eukaryotes, whereas Vibrio cholerae is a bacterium (prokaryote) and H5N1 influenza is a virus (non-living).

2. a. The definitive host of the malaria parasite is the mosquito.
b. The vector of the malaria parasite is also the mosquito.

3. Smallpox elimination was possible because: there are no asymptomatic carriers; the infectious period is short, and the patient is not very contagious before the rash develops; recovery leads to total immunity; there is no animal reservoir; symptoms are easily recognizable; and the vaccine is easy to transport and distribute, inexpensive, and highly effective. (You needed to name any two of these reasons.)

4. a. Viral reassortment occurs when viruses from two separate strains infect a single cell, where they exchange genetic information and create a new, hybrid viral strain.

b. Reassortment of human and bird flu strains is likely to occur in pigs.

AIDS rate soars in nation's capital

Although, as I posted earlier, it is possible that the AIDS epidemic could be brought under control, this is not in fact the case in the US. In fact in some areas the situation is getting much worse.

Reports hitting the press today, based on a report being released tomorrow, suggest that at least 3 percent of the District of Columbia's residents have AIDS, a total that far surpasses the 1 percent threshold that constitutes a "generalized and severe" epidemic.

"Our rates are higher than West Africa," said Shannon Hader, director of the district's HIV/AIDS Administration who once led the Federal CDC's work in Zimbabwe.

'(A)lmost 30 years since the epidemic broke out in the United States, there's still a very real stigma attached to the disease.

Health officials in Washington say that stigma keeps people from getting tested, so the actual rates of HIV-AIDS in the nation's capital is probably much higher.'

More Pork

Nicholas Kristoff continues the Pork/MRSA story in another Op-Ed piece for the New York Times today entitled 'Pathogens in our Pork'.

“We don’t give antibiotics to healthy humans,” said Robert Martin, who led a Pew Commission on industrial farming that examined antibiotic use. “So why give them to healthy animals just so we can keep them in crowded and unsanitary conditions?”

The answer is simple: politics.

Legislation to ban the nontherapeutic use of antibiotics in agriculture has always been blocked by agribusiness interests. Louise Slaughter of New York, who is the sole microbiologist in the House of Representatives, said she planned to reintroduce the legislation this coming week.

“We’re losing the ability to treat humans,” she said. “We have misused one of the best scientific products we’ve had.”

Antibodies Offer a New Path for Fighting Flu

Researchers from Harvard Medical School, the CDC, and the Burnham Institute for Medical Research have engineered antibodies that protect against many strains of the influenza virus, including even the 1918 Spanish flu and the H5N1 bird flu, which could potentially lead to the development of a flu vaccine that would not have to be changed yearly. And, the antibodies already developed could be injected as an effective treatment, unlike drugs such as Tamiflu. Researchers estimate that the necessary clinical trials to prove that the antibodies are safe in humans could begin within three years. The researchers have the support of the National Institute of Allergy and Infectious Diseases, where they have been offered grants and access to its ferrets, which can catch human flu.

http://www.nytimes.com/2009/02/23/health/23flu.html?hp

Agriculture Department Seals Cow Loopholes

Obama closed a loophole in the public health system to make it permanently illegal to slaughter 'downer' cows. These cows are too sick and weak to take care of themselves. Slaughterhouses could use these cows in the food supply for other cows as long as they collapsed after inspection of a non-neurological injury. Downer cows also have a higher chance of having BSE and they lounge in feces which makes E. coli poisoning a risk as well.

http://www.msnbc.msn.com/id/29691788/

Global Warming and Disease

As we touched on in class, here are some issues concerning infectious disease and global warming:

1. As Prof. Latto stated in lecture, insects (mosquitoes and ticks) are greatly affected by temperature. Therefore, as the temperature increases in high altitude and lower temperature areas, new epidemics of malaria may be seen in places never before affected due to the environmental changes.


2. The flu season could be lengthen. As of now, tropical areas experience year-round influenza. As heat and tropical weather expands from the equator, more regions of the world may be susceptible to year-round influenza.]


3. Risk to water supply. As natural catastrophes (typhoons, hurricanes, and other extreme weather) become more common and devastating, infrastructure gets damaged. With inadequate water supply and sanitation systems after extreme storms, the chances of an infectious disease spreading, such as cholera, increase greatly.


4. Global warming will affect agriculture. With droughts and extreme weather, farmers will not be able to grow enough food to support themselves. Thus, they may move to the cities, creating a more dense cities for diseases to invade, especially in third world countries.

A lion in the village

The Cholera outbreak in Africa may finally have peaked:

The number of people dying and infected with cholera in Zimbabwe decreased for the second consecutive week, the United Nations said Wednesday.

The death toll in Zimbabwe has topped 4,000 with more than 89,000 cases since the outbreak of the waterborne disease in August. Its spread is blamed on the collapse of Zimbabwe's water and health infrastructure.

But:

The outbreak in Zimbabwe has put strain on health infrastructure in neighboring countries.

Cholera has doubled to 12,000 cases in South Africa, with the situation along the Zimbabwean border being of particular concern, according to the U.N report. Cholera cases have also almost doubled in Namibia and Zambia.

This week's New England Journal of Medicine contains an article by CDC′s Dr. Eric Mintz, leader of the Diarrheal Diseases Epidemiology Team in the Enteric Diseases Epidemiology Branch:
A Lion in Our Village — The Unconscionable Tragedy of Cholera in Africa that details the burden of cholera in Zimbabwe and other surrounding African countries in the past year.

Unlike the severe acute respiratory syndrome, avian influenza, and other infectious-disease threats that have emerged recently, cholera is easily avoided and easily treated. The failure of the global community to mobilize the resources needed to prevent and to treat cholera among the less fortunate reflects our lack of commitment to equity and social justice. Improving access to safe drinking water, adequate sanitation, and basic health services are among the core Millennium Development Goals agreed to by all United Nations member states.

Epidemic cholera represents a fundamental failure of governance, and bold and visionary leadership is required if we are to attack its root causes. Such leadership has been demonstrated in other contexts in Africa. For example, President Yoweri Museveni of Uganda began to change public attitudes toward the human immunodeficiency virus and succeeded in reducing the rates of AIDS in his country, in part by recharacterizing the disease as similar to any other threat to the community: "When a lion comes into your village," he said, "you must raise the alarm loudly."

It is time to sound the alarm again. Whereas reported case fatality rates for cholera in the rest of the world are now well below 1%, rates in excess of 5% are still commonly reported in many African countries.

Donald Duck Gets Bird Flu

Always thought this was a funny picture - No Donald Ducks were harmed in the making of this image :)

What does a trillion dollars look like?

Whatever the future brings in terms of the US economy I predict that the last few months will have changed the way that we look at very large sums of money. The speed, and apparent ease, with which the government has come up with sums of two hundred billion dollars, seven hundred billion dollars etc because we cannot afford to let the banks/the auto industry/name your industry fail is going to leave people with the idea that these sums of money can be found if the situation is dire enough.

So millions of people die of dysentery/malaria/AIDS/measles/tuberculosis, not because the sums required to help them are too large but because we choose not to help them. That is a fact we always knew but it is going to become increasingly hard to ignore. I'm hardly being original in this observation, I've seen several people make similar comments already and I predict more to come.

Check out this wonderfully simple post if you have ever wondered What does one TRILLION dollars look like? The Federal Government currently raises a little over one trillion dollars in individual income taxes each and every year.

MRSA spread from pigs?

An article in the New York Times today suggests a link between MRSA and pig farming or pork. A doctor in Camden, Indiana, a small town surrounded by hog farms, found a startling number of MRSA cases, and made the link between the hog farms and the infections. He was ready to go public with the insinuations when--he died, at age 54, of a heart attack presumably (though no autopsy was done). Five years ago, some MRSA cases were linked to pig farming in the Netherlands, where a farming family became infected, as well as 8 of 10 of their pigs. In a study of American hog farmers, 45% were infected with MRSA. The article suggests that the antibiotic resistant infection likely developed in pigs due to prophylactic use of antibiotics in animal feed.

Cook your meat thoroughly, and wash your hands after dealing with raw meat!

The Economic Impact of Influenza

Influenza produces direct costs due to lost productivity and associated medical treatment, as well as indirect costs of preventative measures. In the United States, influenza is responsible for a total cost of over $10 billion per year, while it has been estimated that a future pandemic could cause hundreds of billions of dollars in direct and indirect costs. However, the economic impacts of past pandemics have not been intensively studied, and some authors have suggested that the Spanish influenza actually had a positive long-term effect on per-capita income growth, despite a large reduction in the working population and severe short-term depressive effects. Other studies have attempted to predict the costs of a pandemic as serious as the 1918 Spanish flu on the U.S. economy, where 30% of all workers became ill, and 2.5% were killed. A 30% sickness rate and a three-week length of illness would decrease the gross domestic product by 5%. Additional costs would come from medical treatment of 18 million to 45 million people, and total economic costs would be approximately $700 billion.
Preventative costs are also high. Governments worldwide have spent billions of U.S. dollars preparing and planning for a potential H5N1 avian influenza pandemic, with costs associated with purchasing drugs and vaccines as well as developing disaster drills and strategies for improved border controls. On 1 November 2005, United States President George W. Bush unveiled the National Strategy to Safeguard Against the Danger of Pandemic Influenza backed by a request to Congress for $7.1 billion to begin implementing the plan. Internationally, on 18 January 2006, donor nations pledged US$2 billion to combat bird flu at the two-day International Pledging Conference on Avian and Human Influenza held in China.
As of 2006, over ten billion dollars have been spent, and over two hundred million birds have been killed to try to contain H5N1 avian influenza. However, as these efforts have been largely ineffective at controlling the spread of the virus, other approaches are being tried: for example, the Vietnamese government in 2005 adopted a combination of mass poultry vaccination, disinfecting, culling, information campaigns and bans on live poultry in cities. As a result of such measures, the cost of poultry farming has increased, while the cost to consumers has gone down due to demand for poultry falling below supply. This has resulted in devastating losses for many farmers. Poor poultry farmers cannot afford mandated measures which isolate their bird livestock from contact with wild birds (among other measures), thus risking losing their livelihood altogether. Multinational poultry farming is increasingly becoming unprofitable as H5N1 avian influenza becomes endemic in wild birds worldwide. Financial ruin for poor poultry farmers, which can be as severe as threatening starvation, has caused some to commit suicide and many others to stop cooperating with efforts to deal with this virus—further increasing the human toll, the spread of the disease, and the chances of a pandemic mutation.

Quarantine for pandemic influenza

BMC Infectious Disease is an open access journal publishing research articles in all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans.

A question was asked today about whether quarantine would be effective in controlling pandemic influenza and a paper in the current issue, Quarantine for pandemic influenza control at the borders of small island nations, addresses how long a quarantine period would be necessary. They address small island nations because these are the nations most likely to be able to establish quarantine with almost all international arrivals being concentrated at one or a small number of airports.

Quarantine at the borders of island nations could contribute substantially to preventing the arrival of pandemic influenza (or at least delaying the arrival date). For small island nations we recommend consideration of quarantine alone for 9 days or quarantine for 6 days combined with using rapid diagnostic testing (if available).

1918 Influenza Pandemic

It's alright to learn about historical events from lecture, text books, etc, but sometimes I feel like it's more interesting to learn about it from people who lived through it. While I don't know anyone personally who lived through the Influenza Pandemic of 1918 (they'd have to be in their 90s at least!), I found a letter written by a physician who worked with soldiers in Massachusetts. He talks about the conditions in the "wards"...

The normal number of resident Drs. here is about 25 and that has been increased to over 250... We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes Special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows...

Each man here gets a ward with about 150 beds, (Mine has 168)... I have only four day nurses and five night nurses (female) a ward-master, and four orderlies.

He also talks about the symptoms they see when they treat the infected soldiers.

These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen... It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate

2008/2009 Influenza

If you got a flu shot this year in the United States you got vaccinated against the following three strains:

• A/Brisbane/59/2007(H1N1)-like virus
• A/Brisbane/10/2007 (H3N2)-like virus
• B/Florida/4/2006-like virus

Currently the H1N1 strain is the most prevalent in the US and so the vaccine should give good protection. However the current strain of H1N1 is increasingly resistant to Oseltamivir, sold in the US as Tamiflu. The most recent data suggests 96.5% of H1N1 samples tested were resistant causing the CDC to issue a health advisory notice.

Recommendations are already being made for the 2009/2010 vaccine:

WHO has recommended vaccine strains for the 2009-10 Northern Hemisphere trivalent influenza vaccine, and FDA has made the same recommendations for the U.S. influenza vaccine. Both agencies recommend that the vaccine contain A/Brisbane/59/2007-like (H1N1), A/Brisbane/10/2007-like (H3N2), and B/Brisbane/60/2008-like (B/Victoria lineage) viruses. Only the influenza B component has been changed from the 2008-09 vaccine formulation. This recommendation was based on surveillance data related to epidemiology and antigenic characteristics, serological responses to 2008-09 vaccines, and the availability of candidate strains and reagents.

Final Review and Glossary

I added Erin's Final exam review sheet. I made a few very small changes to the glossary (deleted two terms and added one). The changes are listed at the end.

The end of AIDS?

Today we talked about vaccines. Although a vaccine allows us to establish herd immunity to eliminate a disease this is not our only mechanism for disease eradication. If a disease does not have an animal reservoir and only infects humans then we could, theoretically, eradicate it by preventing all transmission. We can do this by altering human behavior (see for example Guinea Worm) or by treating patients so they are no longer infectious.

Efforts to control the spread of AIDS have generally focused on altering human behavior to reduce transmission (eg practicing safe sex, providing clean needles etc). This has had success in some communities and at some times but has never been sufficient to even consider talk of elimination or eradication.

However the latest anti-retroviral drugs are so effective at reducing viral load that those patients on them are effectively no longer contagious. So if everyone with HIV were on therapy, there would be little or no transmission. This raises the fascinating possibility that with a concerted effort we could turn the tide and talk about eliminating, or at least controlling AIDS. For further discussion see the article Are we about to eliminate AIDS? in New Scientist magazine a few weeks ago. Just a couple of excerpts:

It's a simple idea, but the obstacles to implementing it worldwide are enormous. Persuading everyone with HIV to start therapy purely for public health reasons could be ethically dubious. To identify everyone who is HIV positive would require such widespread testing that some may feel it breached their civil liberties. Then there is the question of who would fund such a massive undertaking.
...
In 1985, when HIV testing began, no treatment for the virus existed, so a positive result was effectively a death sentence. Fear of the virus and the fact that it spread most easily among gay men and intravenous drug users meant people with HIV were shunned, as well as being barred from taking out health and life insurance. The decision to have the test was generally an agonising one and many decided it was better not to know.
...
What is certain is that, however and wherever it is attempted, such a scheme will be controversial. Hard-line religious groups that view AIDS as divine retribution are unlikely to help out. Some liberals, on the other hand, might resist the idea of mass testing. "Should we try a social intervention which infringes on people's civil liberties?" asks Conant. "AIDS infringes upon people too. If we're going to stop this epidemic, this is a responsibility that society has to shoulder."

and from the accompanying editorial:

Bankrolling such a long-term programme would cost serious money - initially around $3.5 billion a year in South Africa alone, rising to $85 billion in total. Huge as it sounds, however, it is peanuts compared with the estimated $1.9 trillion cost of the Iraq war, or the $700 billion spent in one go propping up the US banking sector. It also looks small beer compared with the costs of carrying on as usual, which the WHO says can only lead to spiralling cases and costs.

"Sex Positive"

This is a documentary opening March 20th about America's reaction to AIDS in the 1980's with regard to the gay community. It follows the story of activists who preached safe sex early on.

Dr. William Foege and Smallpox

One of the key doctors that contributed to the eradication of smallpox in 1979 was Dr. William Foege, a medical missionary. In 1966, Foege was involved in a certain incident in eastern Nigeria in which there was not enough vaccine shipped in time to inoculate the entire region. After verifying that an isolated village did in fact have a few cases of smallpox, Foege realized that they would have to use a different strategy involving military tactics. They created a network of medical missionaries in an effort to establish surveillance across the region. With this intelligence, they were able to contain the disease by following the people connected to the known infected. Foege’s “surveillance/containment” strategy only vaccinated less than fifty percent of the population rather than the expected eighty to one hundred percent. However, Foege’s strategy was not immediately accepted by the CDC. Many doctors remained skeptical, including Donald Hopkins, who tried the strategy in Sierra Leone. Hopkins was able to eliminate smallpox from the disease-rich region by inoculating less than seventy percent of the population. With Foege’s help, the WHO declared smallpox eliminated from the world. Foege has worked in many sectors of public health, including the Carter Center, which aims to eradicate Guinea worm.

Details can be found here:
http://www.washington.edu/alumni/columns/top10/calling_the_shots.html

Won't somebody think of the ferrets?

Of relevance to both last week and next week is news this week that scientists in Hong Kong and the United States have developed an experimental H5N1 bird flu vaccine for people by inserting five key components of the H5N1 virus into the smallpox vaccine. Why smallpox?

The smallpox vaccine is very cheap, has a long shelf-life of several years and does not require highly sophisticated laboratories, making it easier for poorer countries to produce.

"Smallpox production capacity has gone down but many countries have the technology and the expertise to do it, and if necessary, it can be very quickly scaled up."
"But for other strategies (of producing H5N1 vaccines), it is not possible to rapidly set up manufacturing plants all over the world as they require very specialised plants."

However, it will take at least a few more years before the vaccine would be ready for the market. It must be tested next in ferrets, then monkeys, before human clinical trials can be carried out.

Global Smallpox Eradication

This video shows the work of American physician and epidemiologist D.A. Henderson. He basically led the campaign to eradicate smallpox throughout the whole world. He also opened the Center for Biosecurity and was the head of this organization for many years. He came up with a plan to monitor the disease and if there were any outbreaks. He would then go to this area and vaccinate all of the people in the area, therefore building a wall to block the disease from spreading. He says what motivated him and his teams was knowing that they were "saving people's lives." Watch this video to hear the fascinating story from the man who saved the world from smallpox.

http://www.youtube.com/watch?v=LtQ5JSW2eNk&feature=PlayList&p=B033C2506F0B76EE&index=8

Lost and found

There are things you want to find in a library book, and things you don't. I am an avid reader of books, both library books and used books, and usually come across fairly mundane items - I'd say boarding passes are the most common in used books and grocery store receipts are the most common in library books. However I have come across photographs, letters, and currency.

I don't know how many of you remember this story from a few years back about a librarian in Santa Fe who came across the least popular item ever to be inserted into a book - a small envelope of smallpox scabs. Eeeuww and Arggh!

Smallpox as a Weapon

A disease we took a great effort in eradicating, may be used against us. The use of Smallpox as biological warfare is not unheard of. In fact, Smallpox has been used as a weapon since the 1700s, when the British fought with France for the control of Canada. And as a result, many Native Americans fell victim to the disease and perished.

At the time of the Pontiac rebellion in 1763, Sir Jeffrey Amherst, the Commander-in Chief of the British forces in North America, wrote to Colonel Henry Bouquet: 'Could it not be contrived to send smallpox among these disaffected tribes of Indians? We must use every stratagem in our power to reduce them.' The colonel replied: 'I will try to inoculate the [Native American tribe] with some blankets that may fall in their hands, and take care not to get the disease myself.' (Silent Weapon: Small Pox and Biological Warfare)

A little over 10 years later, in 1775, during the Revolutionary War, the British, once again, used this disease as a weapon, this time in an effort to prevent Americans from taking over Quebec. Apparently, one of the British commanders had civilians, who were immunized against Smallpox, infect American troops, who had no immunity. This resulted in a Smallpox epidemic, infecting about half of the 10,000 American troops.

Nearly 200 years later, during WWII, British and American scientists considered using this infectious agent as a biological weapon. However, this proved impractical, as there were vaccines readily available.

Now that Smallpox vaccinations are no longer distributed, and there is not a numerous supply of vaccinations ready at hand, the use of Smallpox as a biological warfare agent is a scary, but possible thing that can happen in our terror-filled world.

Global Polio Eradication

Keep track of the battle against Polio at polioeradication.org. This is where you can find a weekly update, maps, and numerous interesting reports and documents. I found this report interesting because it really brought home the magnitude of the task:

In the teeming streets of Uttar Pradesh, ensuring each of the estimated 38 million children in India's most populous state is immunized remains one of the global polio eradication initiative's greatest challenges. Here, more than 400,000 children are born every month and until recently, up to half those names were not making it onto the official government registry.

Week by week, mobile polio immunization teams, which literally walk from house to house throughout Uttar Pradesh to ensure blanket immunization coverage, continue to find unregistered, unimmunized newborns. These infants are not only susceptible to contracting polio; they also act as a reservoir for the virus to survive in the community and make for inaccurate immunization coverage figures.

The New Philanthropists

Warren Buffett, who has given at least 40 billion dollars to health, education and humanitarian causes.

If you read anything about malaria control and elimination one name crops up again and again - Bill Gates, or more precisely the Bill and Melinda Gates Foundation. He is not alone in his generosity though. I was doing a quick fact check to see if he is still the world's richest man (he held this title for 15 years but slipped to number 3 last year) when I noticed some similarities between the (current) three richest men in the world:

1/ Warren Buffett. Worth $62 billion. Self made. Plans to give away ALL his fortune and has already given $31 billion to the Gates Foundation.

2/ Carlos Slim Helu and Family. Worth $60 billion. Self made. In recent years, he has donated close to $7 billion worth of cash and stock to fund education and health projects in Mexico City.

3/ Bill Gates. Worth $58 billion. Self made. As of 2007 Bill Gates was the second most generous philanthropist in America (after Warren Buffett), having given over $28 billion to charity.

I don't know if there is a connection between the fact that all these men made their own fortunes rather than inherited them, and their conspicuous philanthropy, but they are definitely powerful players in the global fight against disease. There have been several articles about these new philanthropists. This one, from Business Week, makes some very interesting points that we have seen in the fight against both Aids and Malaria in Africa.

This new philanthropy displays an impatient disdain for the cautious and unimaginative check-writing that dominated charitable giving for decades. So what does it look like?

• It's more ambitious: Today's philanthropists are tackling giant issues, from remaking American education to curing cancer.
• It's more strategic: Donors are taking the same systematic approach they used to compete in business, laying out detailed plans that get at the heart of systemic problems, not just symptoms.
• It's more global: Just as business doesn't stop at national borders, neither does charitable giving. Donors from William H. Gates III to George Soros have sweeping international agendas.
• It demands results: The new philanthropists attach a lot of strings. Recipients are often required to meet milestone goals, to invite foundation members onto their boards, and to produce measurable results--or risk losing their funding.

Killer Mosquitos

This is actually shot like a scary movie..... KILLER MOSQUITOES bommmm bomm BOMMM!!! This first appeared on the Discovery Channel. It describes an insidious killer, the mosquito. This video includes live footage of mosquitos as well as animated depictions. Watch it for some definite entertainment.

http://videos.howstuffworks.com/discovery/28336-discovery-magazine-killer-mosquitoes-video.htm

Prototype Developed for New Malaria Testing

Could a new form of medical testing for developing countries be found far from any laboratory -- in a dehydrated, wallet-sized, disposable Mylar card?

These prototype cards, recently described in the journal Lab on a Chip, are part of a long-term project funded by The Bill and Melinda Gates Foundation's Grand Challenges in Global Health Initiative. The point is to develop “affordable, easy-to-use diagnostic tools for the developing world” that “use features of common lab tests and take into account portability, automation and easy storage.”

In order for this technology to work, the tests must be storable for long periods of time at ambient temperatures. They plan to use the astronaut-food approach, where the reagents are dried down to successfully store them without refrigeration. This is key for physicians diagnosing patients in poor countries around the world because many lab tests contain ingredients that must be kept cold, but often no refrigeration is available.

This test must also be developed to be fast and easy to use, since health care workers might only have one visit to diagnose and treat a patient. In these cases, they do not have time to wait days for lab results. While the prototype developed only tests for malaria, cards of the future will hopefully also test for other high-fever diseases like dengue, influenza, typhoid, and measles.


This card is part of a system hoping to diagnose malaria away from a lab. The red circle at the center contains dehydrated antibodies that can be stored for months without refrigeration. The tiny channels guide a blood sample through the card to the white rectangle. Upon getting there, a red spot will appear, and its intensity shows whether the patient is infected.

Click to read more about this project.

The Uncultured Project

Talking about malaria this week in class made me remember a video that I saw on Youtube a while ago. Basically, a guy named Shawn, who was a grad student at Notre Dame, decided to do something about the poverty situation of the world, and moved to Bangladesh. Since then, he has been collecting donations in order to do as much as he can to help the people he has met. One of the things he's been doing is buying mosquito nets. Like we learned in class, these nets are inexpensive and can do wonders to prevent the spread of malaria. Below is a video that Shawn made specifically about malaria in Bangladesh.

You can also visit his Youtube channel or his website to find out how you can help him continue the good work that he's doing.

Malaria May Fuel Spread Of HIV In Sub-Saharan Africa

ScienceDaily (Dec. 7, 2006) — Malaria may be fueling the spread of HIV in areas of sub-Saharan Africa where there is a substantial overlap between the two diseases, while HIV may be playing a role in boosting adult malaria-infection rates in some parts of the region, according to a new study by researchers at Fred Hutchinson Cancer Research Center and the University of Washington.
The findings, published in the Dec. 8 issue of Science, found that because malaria increases the viral load of an HIV-infected person on the order of 10 times, it makes HIV more transmissible to a sex partner. Conversely, HIV may play a role in the geographic expansion of malaria in Africa because HIV-infected persons are more susceptible to malaria infections due to their already-compromised immune systems, according to study co-authored by Laith J. Abu-Raddad, Ph.D., Padmaja Patnaik, Ph.D. and James G. Kublin M.D., M.P.H.
"While HIV/AIDS is predominantly spreading through sexual intercourse, this biological co-factor induced by malaria has contributed considerably to the spread of HIV by increasing HIV transmission probability per sexual act," said Abu-Raddad, an HIV/AIDS research scientist in the Hutchinson Center's Statistical Center for HIV/AIDS Research and Prevention and the Center for Studies in Demography and Ecology at the University of Washington.
"In turn, the weakening of the immune system by HIV infection has fueled a rise in adult malaria-infection rates and may have facilitated the expansion of malaria in Africa," said Kublin, an HIV/AIDS scientist in the Hutchinson Center's Clinical Research Division.

Disease and Poverty

One survey asked rural Africans what they would buy if they had the money. A bed net was sixth on the list. The first three items were a radio, a bicycle and, heartbreakingly, a plastic bucket.

We touched on the issue of disease and poverty today. There was a very nice Op-Ed article in the New York Times a few years ago entitled The Scandal of 'Poor People's Diseases'. I think the author, Tina Rosenberg, makes some very good points and I'd encourage everyone to read this article.

She had written a previous article for the New York Times under the somewhat contentious heading 'What the World Needs Now Is DDT', and this is probably the most controversial part of her article.

American officials maintained it was hypocritical to push an insecticide overseas that is banned at home. Americans are beginning to realize, however, that it is more hypocritical to deny Africa the ability to use responsibly the tools we used irresponsibly to beat malaria.

For a counter argument see Sonia Shah's article in The Nation: Don't Blame Environmentalists for Malari. However disagreement over the importance of DDT for malaria elimination should not detract from the rest of Rosenberg's argument.

Mildly Relevant Trivia!

in the last 24 hours, I have come across two references to diseases covered in this class in pop culture:

Plague
In the movie "Muppets from Space," Rizzo the Rat defends himself by saying "...and I never carried the plague, not even once."

Toxoplasmosis
Apparently, tennis player Martina Navaritilova once lost a $500,000 dollar match when she had toxoplasmosis. Pathological disease, or convenient excuse?


hopefully I didnt repeat anyone else.

Malaria map

Worldmapper is an interesting tool that visually depicts geographic data by distorting the size of countries to display the data. They have a number of such maps for diseases - above you can see malaria cases.

Once you have got an idea of how the data is being presented try to imagine what the figure will look like before you click on it. Try the following:

• Cholera cases
  
• Tuberculosis cases
• Rabies deaths

And some older posts of relevance:

• Specicide - Are there species that we should deliberately drive to extinction?
• Malaria control for the 21st century - The Star Wars Mosquito Defense System
  

Pesticides No Longer Futile

British researchers isolated the gene that gives mosquitoes resistance to pesticides. They also now know that these genes are very similar between species of mosquitoes. Humans do not have these genes so it will be safer to target in mosquitoes, even in the presence of humans.

http://www.msnbc.msn.com/id/29020874/

Manslaughter

Can you tell which one is real and which one is fake? Now imagine your life depends on it.

Developing drugs that target the Plasmodium parasite that causes Malaria is difficult. But what makes matters much worse is that the parasites have shown a remarkable ability to evolve resistance to drugs.

This whole situation is made much worse by the problem of fake drugs which may contain an insufficient amount of active ingredient or none at all.

Natural selection alone can cause diseases to mutate, but resistance is greatly exacerbated by growing numbers of counterfeit and sub-standard drugs, especially in poor countries.

These often contain some correct active ingredients but not enough to cure, just enough to encourage mutation and resistance.

A PLoS paper in 2006, Manslaughter by Fake Artesunate in Asia—Will Africa Be Next? pulled no punches:

We make no apology for the use of the term manslaughter to describe this criminal lethal trade. Indeed, some might call it murder. Somewhere, people are directing a highly technical and sophisticated criminal trade. They are making tablets out of starch, chalk, and a variety of wrong active ingredients, such as erythromycin, for a life-threatening disease that particularly affects the poor and underprivileged. The criminals are making these fakes in the full knowledge that their ineffective product might kill people who would otherwise survive their malaria infection.

This week's reading for section

Don't forget to download and read the Lafferty Toxoplasmosis paper for section! The link is at the bottom of the list on the right.

Epidemiology & Public Health as a Career Option

To be completely honest, I selected EEMB 40 because it sounded like the most interesting course on the Winter 2009 Honors courses list. Soon, I found myself to really enjoy the material, possibly because it has a lot to do with public health, which I personally want to pursue in the future.

For those who might be interested, epidemiology is one of the five core disciplines offered at every CEPH (Council on Education for Public Health) accredited school. There are about 40 of these certified public health schools, including 4 in California (UC Berkeley, UCLA, San Diego States, & Loma Linda). The ASPH (Association of Schools of Public Health) lists possible career titles in the Epidemiology field: Director of Infectious/Chronic Diseases, Outcomes Researcher, CDC Investigator. Public health is very diverse and growing field; those pursuing a career in public health may work in a broad range of sectors.

www.asph.org
www.whatispublichealth.org

A few websites I found to be very helpful. For some reason, I haven't been able to post links on my posts.

Prions and Science

Representative virus-like arrays of 25-nm particles

Non-scientists are sometimes surprised to find how open-minded science actually is. There is room for everyone - with the slight caveat that if you are going to do science you need to do it in a scientific way.

So, for example, I mentioned that although the majority of scientists now accept the prion hypothesis for diseases like Kuru, CJD and BSE, there are still a few who do not. Science is not a democracy - we don't vote for a favorite hypothesis and then make everyone accept the conclusion. Rather, one of the strengths of science is that there will always be people who are testing hypotheses even after most people accept them. This is a good thing because it either strengthens the evidence for the existing hypothesis or leads to a new, and better, one.

One of the prion hypothesis skeptics is Laura Manuelidis, a professor of neurobiology at Yale University Medical School. She believes that the prion proteins are not infectious, but are a pathological result of an infectious virus binding to this host protein. Two years ago she published a paper in the prestigious journal Proceedings of the National Academy of Sciences, Cells infected with scrapie and Creutzfeldt–Jakob disease agents produce intracellular 25-nm virus-like particles, which describes, as the title suggests, the discovery of virus-like particles in the brain tissue of animals infected with so-called prion diseases.

There is a newspaper article about her work which provides a popular summary and some response to her PNAS paper:

Neurobiologist Kamel Khalili said he has seen the electron microscopy images from the new paper and the particles certainly look like viruses.

There is a large body of evidence supporting the prion theory, albeit circumstantial, he said. "We must always keep our minds open," said Khalili, chief of neuroscience at Temple University School of Medicine.

Kuru, Balderdash, and Web Design

I was really excited when we learned about kuru last week because of a personal experience I had involving kuru. (Before you get worried--I am not a cannibal, nor do I know anyone who is, and I don't have kuru.) During Winter break I played Balderdash with my cousins and I was trying to find a short but obscure word for my turn. I happened to be in the K's in the dictionary and I found the word "kuru." I hadn't ever heard of it before, but I decided to use it. Turns out my cousins hadn't heard of it either and I won a lot of points from that round.

Today I was looking on the internet for articles about kuru and I happened across a "content, marketing, and public relations" company (web design company). They are called Kuru Heavy Industries. The company itself has nothing to do with kuru, but I found it amusing that they referenced the deadly disease on their "about" page:

We at Kuru deal in content, which is nothing more than the transmission of ideas and information. Hence the name.

and

Kuru: content that fries your brain.