Lions, Tigers, & Bears or Anthrax, Smallpox, & Bird Flu

Today it was announced that the recently discovered smallpox vials contained viable virus that was infectious. This is not too unexpected given that these were freeze-dried specimens.

However, the other piece of news that accompanied this announcement was that, over the last decade, there were 5 lapses in which dangerous pathogens, including the H5N1 influenza virus, were sent improperly to other laboratories from the CDC. The revelation of these incidents has prompted CDC to cease operations at two labs and impose a "moratorium" on specimen shipping from some CDC labs. 

What strikes me as the most important part of the story, however, is the issue of the Select Agent Rules. After the anthrax attacks of 2001 there was a major effort by the US government to impose strict control on the laboratories doing work on certain pathogens that were particularly dangers (hence, select agents).

Many university laboratories, including the ones in my own institution, struggled to meet these requirements. I personally know of one tularemia researcher who had particular difficulty meeting all the regulatory requirements to receive a non-virulent strain of the bacterium.

This laxity by some government personnel gives the impression that although university labs work diligently to comply with such regulations, their government counterparts have not exerted the same level of diligence. The belief that a two-tiered system exists coupled with the lapses that have occurred is something that could harm the public's confidence in this vital research and potentially jeopardize it -- a scenario that is more dangerous than finding decades-old smallpox vials.

Who Left Their Smallpox in the Closet?

The revelation that 6 vials of smallpox--the only human disease mankind has eradicated--were found in an FDA storage room at the NIH will likely grab headlines and spark concerns of a smallpox outbreak. However, I do not anticipate this event will amount to much. 

As is widely known, smallpox was eradicated from the planet in the 1970s and vaccination soon stopped. This cessation of vaccination has rendered most of the population susceptible to smallpox...if it were to return through an accidental lab release or deliberate attack--a major concern for those in the fields of biosecurity and bioterrorism.

In the post-eradication era, the known stocks of the virus are kept in secure locations at the CDC in Atlanta and the Vector Institute in Novosibirsk (Russia). The retention of the virus has sparked continual debate at the World Health Assembly regarding whether these stocks should be destroyed or retained. 

Further testing remains to be performed to determine whether what was found at the NIH was viable virus and the fact that it was freeze-dried may have preserved infectivity. Indeed, the vials have tested positive for smallpox DNA and the next step will be to assess whether the virus can be cultivated in culture. Nevertheless, though these vials do not pose any risk to the general public, the fact that forgotten stores of the deadly virus exist in the US makes it all the more possible that such remnants exist in other parts of the world. 

Another Tangle with Norovirus

I hate norovirus. This entity, which seems to seek me and my sweet type-O blood out, has infected me again.  I'm not in anyway unusual, this virus causes 20% of gastroenteritis cases. 

As someone who has had norovirus a few times, I've been able to recognize the tell-tale warning signs that something explosive is about to come. First, I usually have a sense that my stomach is not emptying fully. This is the result of the virus' action to ensure it has enough projectiles to hitch itself onto to make its way to another host. Next, hyper-salivation. Then, the run to the bathroom to vomit violently--this often just starts like a flick of the switch. Chills and muscle aches and pains usually follow.

Today, I was ready (or so I thought). As soon as I felt that delayed emptying sensation, I took an anti-emetic medication. However, it was too little too late. Though, it has kept the vomiting at bay for now.

Norovirus is so successful because of its contagiousness--when someone vomits they are a super spreader whose vomitus remains infectious. Additionally, the virus is resistant to standard cleaning agents (e.g. alcohol), making clean up challenging. 

I wish there was a vaccine.

A Book Not To Neglect

I had the opportunity to see Dr. Peter Hotez speak when I was an infectious disease fellow about 6 years ago. What initially sparked my curiousity about this innovative physician was that one of my mentors at the time, Dr. Tara O'Toole, who was soon to become the Department of Homeland Security's Undersecretary for Science and Technology, had spoken very highly of him. At the time I was immersed in understanding the concepts biodefense and wondering in what way this hookworm maven would impact my understanding of biodefense and national security.  

Needless to say Dr. O'Toole was right (as usual) about Dr. Hotez and I learned quite a lot from his lecture. 

I recently got the chance to read his book Forgotten People, Forgotten Diseases: the Neglected Tropical Diseases and their Impact on Global Development. The book is devoted to detailing the main historical, clinical, and epidemiological features of the major NTDs--a cast of characters that includes hookworm, ascariasis, onchocerciasis, schistosomiasis and others. His discussion of toxocariasis in the US is especially fascinating.

The main strength of this book is not just that Dr. Hotez provides subject matter expertise, he leverages that expertise to integrate the knowledge of these diseases with what he knows about the locales in which these diseases are endemic. What Dr. Hotez argues, quite effectively, is that these diseases represent major barriers to economic development. In effect, individuals afflicted with these disease die earlier and/or are less productive. When entire regions are infected, the effects are magnified. 

Importantly, Dr. Hotez highlights the fact that such diseases are often coincident with civil wars and  factional fighting--something I think is instrumental in why these diseases persist (something I plan to write more on).

There's much more to say about this book and I recommend it.

If Darwin Met Pasteur and Koch

When I get into arguments on evolution--unfortunately a frequent occurrence in my hometown--I reflexively point to microbes and their impressive ability to evolve new properties literally right before one's eyes (viz. antimicrobial resistance) as incontrovertible evidence of the veracity of evolution by means of natural selection.

I have often wondered how much further mankind's knowledge would be if the genius Darwin had the microbial world to draw from when identifying the earth-shattering facts he did. 

An esteemed group of microbiologists has picked up Darwin's mantle and written a collection of essays that melds Darwinian principles with cutting edge microbiology. The collection is appropriatley entitled Microbes and Evolution: The World Darwin Never Saw. The essays in this book, by making bold new integrations, furthers the philosophy of biology and provides a plethora of ideas to spend hours chewing. 

The essays have varied topics but each illustrates the simple elegance of evolutionary machinery at work on the 3 kingdoms of life (Archae, prokaryotes, and eukaryotes) alike. For an infectious disease physican who hasn't delved enough into "pure" (non-medical) microbiology, the book was a treasure trove.

I highly recommend it.