Finding Needles in Haystacks

The journal Emerging Infectious Diseases recently published a case report of a novel virus that infected a wildlife biologist working with bats in Uganda and South Sudan. The patient became ill upon return to the US and her symptoms--fever, myalgias (muscle pains), arthralgias (joint pain), and rash--were severe enough to warrant hospitalization. As part of the workup of her illness, samples of her blood were sent to CDC where a novel paramyxovirus, related to known bat viruses, was isolated. It has been named Sosuga virus. 

A couple of elements of the case really highlight where zebras are best found (i.e. novel viruses):

• The case patient was a wildlife biologist, someone who operates at the interface of humans and animals. 
• The case patient travelled to Uganda and South Sudan, areas that are considered hot spots for novel pathogens given the geographic diversity of the flora, fauna, and wildlife found there. 
• As bats are one of the most populous mammal species on the planet, it is not a surprise that they are a major source of zoonotic infections. As such, exposure to bats is a known risk factor for disease acquisition. Several emerging infectious diseases are linked to bats (SARS, Hendravirus, Nipah virus, Ebola, and Marburg) as well as classical diseases such as rabies. 
• Hendra and Nipah viruses, both acquired from bats, are also paramyxoviruses. 

This case exemplifies the value of targeting pathogen discovery to the highest yield venues, making the needle in the haystack a little more visible.

Organizing Chaos: Hospital Evacuation During Hurricane Sandy

The results of a study my colleagues and I conducted on the topic of the hospital evacuations that occurred during Hurricane Sandy in New York City was just published in Annals of Emergency Medicine. Our study was focused on understanding the impact that the evacuations of Bellevue and NYU Langone had on the hospitals tasked with absorbing the displaced patients and the subsequent patient surge caused by the months-long absence of these 2 major Manhattan medical centers.

Some of our important findings included:

• Hospital emergency managers viewed themselves as part of a coalition and act accordingly (i.e. turn to each other for help)
• Moving complex patients at tertiary centers required a lot of communication between physicians adept at managing such patients
• Utilizing out-of-state ambulances (as was done when FEMA-contracted ambulances were brought in) posed logistical problems because of unfamiliarity with the city and its hospitals
• Planning for special populations is crucial (e.g. dialysis patients, methadone patients)
• Sustained surge required hospitals to remove slack in the system and convert open-space into patient care areas
• Credentialing of displaced physicians was challenging, but feasible
• Hurricane Irene conditioned the response

Our hope is that the study will help inform how hospitals plan for evacuations and other catastrophic health events in the future and serve as the basis for making an unavoidably chaotic process as smooth as possible. 

Herpes at the Golden Globes?

Last night Alfonso Cuarón, upon receiving the Golden Globe for best director for Gravity, spoke about how his accent confused actress Sandra Bullock who heard "I'm going to give you herpes" when he was actually talking about an earpiece.

The truth is the majority of the population already has herpes, the infection caused by herpes simplex virus (HSV). The word herpes is Greek and means "to creep", a reference to the creeping skin lesions characteristic of the infection.

Herpes comes in two varieties: HSV-1 and HSV-2. HSV-1 is generally considered to cause oral herpes, while HSV-2 is associated with genital herpes. For obvious reasons, these demarcations are quite fluid and anything goes. 

By the time an adult reaches their 40s, 90% have been infected with HSV-1. Although only 17% of US adults have been infected with HSV-2, this rates varies based on demographics with 80% of African American women infected. Once infected with the virus, a person is at risk for subsequent attacks as the virus is not cleared from the body. However, herpes can be successfully treated with antivirals such as valacyclovir, famcyclovir, and acyclovir. 

As almost everyone has had a "cold sore" or "fever blister" (gingivostomatitis) and has oral herpes, there really should not be any stigma associated with this universal disease. Getting herpes is part and parcel of the human condition, much like catching a cold or breaking a bone, and not creeping death (Metallica reference and pun intended).

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.

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 Contagion, probably 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.