Your Shoes Remind Me of Smallpox

A few days ago I noticed my stylish neighbor and friend's new shoes and was immediately reminded of smallpox. That might seem an odd connection but look at them.

Smallpox is a disease that has cut a huge swath into human history. The successful effort to eradicate smallpox began with the inception of vaccination by Edward Jenner and stretched to the fatal blow to the disease struck by DA Henderson centuries later. 

Not only has smallpox been a natural scourge on human populations, but it has also been attempted to be used nefariously multiple times. For example, it was employed by the British army in the French and Indian War. Other times when smallpox may have been used as a weapon of war include by the British army against Washington's army and the Confederate army against the Union army. In fact, General Washington had the Revolutionary Army variolated--a precursor to vaccination--in the event of British use of the virus (see this hand written letter by Washington on the issue).

Iraq and the former Soviet Union had also weaponized the virus.

Current debate regarding smallpox is centered on whether the last remaining known stocks of the virus, kept at the CDC and by the Russian government, should be destroyed. This year's World Health Assembly in Geneva will decide the question. 

Smallpox shoes may be in vogue, but I prefer Vans.

 

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Helix: "When We Drop The Ball, Thousands Die"

Last night the SyFy network debuted a new drama program called Helix. The show is focused on the efforts of a CDC team tasked with investigating a mysterious disease outbreak at a remote Arctic research station. 

Following a general trend in movies portraying viral infections--exemplified by Resident Evil and 28 Days Later--the individuals infected with the unknown virus exhibit symptoms of aggression coupled with superhuman strength and a zombie-like appearance. Interestingly, this virus spreads through a gross pseudo-French Kiss mechanism! Although this symptom complex is a favorite of Hollywood, it really doesn't exist in reality (rabies and other forms of encephalitis are a far cry from these depictions, however, they are as close a match as there is).

Though the show requires one to somewhat suspend disbelief at times, something especially hard for an infectious disease physician, it is entertaining. Plus, hearing the terms BSL-4, zoonosis, Ebola, Marburg, and icosahedron on television is always fun.

I am pleased that such a program is being aired for it shows the vital importance of managing infectious disease outbreaks before they are given the opportunity to spread to the general population. As the main character, Dr. Farragut, states, "When we drop the ball, thousands die."

By portraying the exciting and intellectually stimulating work that infectious disease physicians, epidemiologists, veterinarians, microbiologists, and scientists perform to combat infectious diseases such programs potentially serve as inspiration for those contemplating careers in the field and foster some familiarity with the process amongst the public.

When Contagionprobably the most scientifically accurate film in this genre, was released my colleagues and I hoped it might spark a Top Gun-like surge in interest in these fields, Helix could also serve that purpose.

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.