Those Who Oppose Vaccines are the Real Crazy Ones

Last night during an episode of the CBS comedy The Crazy Ones, the character played by Sarah Michelle Geller (of Buffy the Vampire Slayer fame), made a plug for influenza vaccination. When some other characters demurred, she replied "Blame Jenny McCarthy". I tweeted about that exchange and it prompted Ms. Geller to make me one of her "Follow Friday" selections. 

Edward Jenner's 18th century identification that cowpox was protective against smallpox changed the world and gave birth to the vaccinology. It also spawned the anti-vaccine movement. See Paul Offit's masterpiece Deadly Choices, which I reviewed for JAMA--a piece of my own writing of which I am especially proud.

That we are still engaging in the same debates that Dr. Jenner did is baffling to me given how vaccines, 2 centuries after Dr. Jenner's heroic efforts, have--almost singlehandedly--been responsible for the massive growth in the human lifespan. The current burden that exists  with respect to pertussis, measles, mumps, and even polio (in Northern Nigeria) can be linked to the misguided anti-vaccine movement.

In recent years, we have seen celebrities leverage their ability to reach large audiences to spread the anti-vaccine message. (I can think of only one celebrity on the pro-vaccine side, Amanda Peet). Jenny McCarthy has been one such celebrity who, after the tragic development of certain neurologic symptoms in her son and his subsequent diagnosis of autism, became an outspoken critic of vaccines. Though no link exists between vaccines and the development of autism and academic fraud was responsible for the initial positing of the link, it is extremely difficult to persuade people away from this falsehood. 

Sarah Michelle Geller and the writers of The Crazy Ones deserve praise for not being the crazy ones by honoring the legacy of Edward Jenner. 

Intestines in the Time of Cholera

The world has experienced 7 cholera pandemics since 1817. The first six were caused by the classic biotype of the O1 serogroup of Vibrio cholerae. The 7th pandemic which began in 1961 and is still ongoing (with spread to Haiti and Mexico) is due to the less virulent El Tor biotype of O1 V.cholerae.  In a project, my colleagues and I estimated global cholera costs as exceeding $3 billion annually. 

It was in 1849 during the 2nd pandemic that Dr. John Snow made his pathbreaking epidemiological discovery regarding the role of water in the spread of the cholera microbe--yet to be identified (see The Ghost Map and The Strange Case of the Broad Street Pump). During that pandemic, Dr. John Neill of Philadelphia preserved an intestine from a patient for further study.

The New England Journal of Medicine just published the results of a successful attempt to extract the cholera microbe from that over-a-century old specimen. 

The bacterium recovered was of the classical biotype (as predicted) and had a striking similarity to the reference strain of the classic biotype suggesting that little evolution has occurred since 1849 because of some selective pressure that is constraining its genome. 

Cholera is a fascinating disease--see its biography--and this study fills in a few chapters in its life with humans.

Bird Flu: Flying North to Canada

The Canadian Press is reporting an imported case of H5N1 avian influenza--which was fatal-- in the province of Alberta. From press reports, it appears the infected person traveled to Canada from China. Contact tracing is ongoing, however the highly fatal H5N1 (unlike seasonal influenza) does not efficiently spread between people.

The press report also states that the hospital did "everything it could." In the coming days it will be interesting to find out the clinical course of this patient and what interventions were attempted (e.g. prone ventilation, ECMO, peramivir, zanamivir, etc.) 

Though this is the 1st case of H5N1 identified in North America, it is not surprising that such a case has finally occurred given the density of travel. 

Dallas Buyers Club: Bureaucracy vs. Life

Today I saw the movie Dallas Buyers Club and I thoroughly enjoyed it. The movie is focused on the early days of the AIDS pandemic in America and the struggle to find effective treatments.

Circa 1985, there was little a physician could do to forestall the inevitable death sentence imposed by the diagnosis of HIV infection. The movie portrays the real life efforts of Ron Woodruff to bring novel anti-HIV medications to the US, despite staunch opposition from the FDA.

Woodruff, expertly played by Matthew McConaughey (nominated for awards for this role), displays heroic intransigence in the face of a diagnosis of AIDS and the opposition of the FDA to his work. Throughout the film, it is the FDA that poses a greater threat to his life than the deadly virus because of their insistence that the drugs he employs, some of which were later FDA approved (e.g. ddC) were not safe and merited confiscation and destruction. Another drug Woodruff imported, Peptide T, may yet also find a place in the treatment of HIV.

Today, efficectiveHIV drugs are plentiful. This situation is due, in part, to the efforts of AIDS activists who would not allow bureaucracy to stifle their will to live. However, not all diseases share this status and many conditions could benefit from the efforts of a Woodruff-like character.

The tagline for the movie--"Dare to Live"--is a perfect encapsulation of Woodruff's heroism. We should all follow his example.

Snap, Crackle, Pop: You have Malaria

 Malaria, historically one of mankind's perpetual scourges, continues to devastate populations of humans worldwide. While effective treatments are available, the condition must be diagnosed first--a challenge in resource poor areas.

The diagnosis of malaria is based upon the  visual identification of parasites in a blood sample. Rapid antigen detection tests and PCR can also be used on blood samples.

A novel method, devoid of the need for blood samples, has just been described in a paper published in PNAS. The New York Times reported on the finding. 

The test is based upon detecting the acoustic signature of hemozoin molecules which are degradation products generated by the malaria parasites feasting on the red blood cell's hemoglobin. Using a laser device, hemozoin molecules can be vaporized and the acoustic signature of that process detected allowing malaria to be diagnosed.

Such a test, if technically feasible and scalable, has the potential to transform the way malaria is diagnosed enhancing accuracy and speed while diminishing the need for laboratory and phlebotomy equipment--potentially a giant leap forward.