It's often said--not without reason--that technology is the solution to infectious disease.
However, microbes can exploit that very technology to find routes into the body. Witness prosthetic joint infections, for example.
The fact is that just as we use technology to enhance our lives, so do microbes.
Case in point: the exploitation of hook-up apps by syphilis. By facilitating sexual encounters such apps also facilitate syphilis transmission.
Talk about a 21st century problem.
A fascinating look at how infectious disease can adversely impact cognitive development was recently published in the Journal of Infectious Diseases. In this study, cognitive function was studied in three age groups: children, adults aged 20-59, and older adults. The study assessed the effect that two herpes viruses (HSV-1 and CMV) had on performance.
The study found in children that seropositivity for HSV-1 was correlated to lower reading and spatial reasoning schools. In adults aged 20-59, seropositivity to HSV-1 and CMV was correlated to impaired coding speed and seropositivity to CMV was correlated to impaired learning and recall. In older adults, seropositivity to HSV-1 was linked to impaired immediate memory.
The implications of this study are that infection with these pathogens have wide-ranging effects that can substantially alter one's functional capacity. Indeed, both of these pathogens may have roles in Alzheimer's Disease as well. Preventing infection with these ubiquitous pathogens may prove difficult in the absence of a vaccine, however.
In the midst of news regarding measles and pertussis, two diseases enjoying resurgences due to lack of immunity from lax vaccination attitudes (see this Pittsburgh Tribune Review article), mumps also appears to be making a comeback. In fact, however, the 2014 outbreaks at Fordham and Ohio universities are part of a trend that began in the US around 2006.
In contrast to the other vaccine preventable diseases, mumps appears to be somewhat mysterious in that it occurs in highly vaccinated populations and not in those lacking immunity. Such outbreaks didn't occur pre-2006 which leads to several questions:
Overall, though mumps is a much less virulent disease than measles and has less individual--and public health--import.
Here in Pittsburgh a 6 year old boy died from bacterial meningitis this week. There was some interest from the media and the county health department held a press conference to announce some of the specifics of the case, including the important fact that the culprit organism was treptococcus pneumoniae (the pneumococcus). As such, no major public health intervention--such as antibiotic prophylaxis--was needed.
However, children dying of invasive pneumococcal disease is not something that should be considered commonplace in light of the availability of pneumococcal vaccines. The really are two pneumococcal vaccines that are relevant: the traditional 23-valent pneumococcal polysaccharide vaccine targeted primarily at the elderly and 13-valent (formerly 7) pneumococcal conjugate vaccine targeted primarily at children.
While an important question will be whether the child was vaccinated and if the specific pneumococcus isolated was a vaccine serotype, I wonder what the pneumococcal vaccine rate is in his neighborhood.
I think about this because of an innovative approach employed in Philadelphia for a similar problem that I once heard about in a lecture. In Philadelphia, rates of invasive pneumococcal disease are mapped with vaccination rates. Such an approach uncovers areas in which vaccine--which reduces carriage rate as well as infections--should be prioritized. The approach is reminiscent of the surveillance and containment approach used to eradicate smallpox.
A few new developments regarding the potential for an HIV cure are sparking a round excitement. There are several manners in which an HIV cure--as opposed to a preventative vaccine--is being pursued.
The first is in a manner such as with The Berlin Patient, a man who developed leukemia in the setting of HIV and underwent a bone marrow transplant with cells lacking the HIV co-receptor CCR5. This is the subject of a new book I'm eager to read.
The other avenue is that taken by the Mississippi baby. In this case, a child born to an HIV positive mother--who did not receive prophylactic treatment--was immediately placed on antiretroviral therapy for a period of time. That treatment has since stopped and no detectable virus has been found in the child's blood. A similar procedure was recently reported in Long Beach. A larger trial is being planned. Similar results have been shown in adults in the Visconti cohort, albeit a small amount of viral material presents.
The final approach is novel and involves using genetic engineering to remove the CCR5 co-receptor from a person's T-cells and then re-infusing them. Such infusions of T cells lacking this receptor were found to die much less slowly than their HIV-vulnerable counterparts, in the absence of treatment, and also to be safe.
Taken as a whole, the potential success of curative treatments and an efficacious vaccine have the potential to change the dynamics between HIV and the human race.