What do Tippecannoe, Typhoid, and the Dallas Cowboy Cheerleaders Have in Common?

In several media interviews I've done on Ebola, I've been asked about historical examples of infectious diseases contributing to the demise of nations--a real fear in Liberia. Some of the examples I've given include: the Aztec Empire & smallpox; Napolean's army and typhus; Justinian's Plague & the Roman Empire; and the Plague of Athens & the Athenian Empire. 

In the US, infectious diseases have made their mark on history too. Think of the Panama Canal and Yellow Fever or the Yellow Fever epidemic in Philadelphia. A recent paper, published in the journal Clinical Infectious Diseases, adds another to the list: the death of President William Henry Harrison.

Renowned medical historian and infectious disease physician Dr. Phillip Mackowiak, whom I've had the pleasure of hearing dissect the death of Alexander the Great, challenges the long-held notion that President Harrison died from community acquired pneumonia--a leading killer even today. 

In its place, Dr. Mackowiak suggests typhoid fever and based on the notes of President Harrison's personal physician it seems to be a convincing argument. One clue is the President's lack of an accelerate pulse, a hallmark of infection with Salmonella typhi.

In fact the single case of typhoid fever I've diagnosed had me anchoring my conclusion to just that. Staring at a college student with a fever of 104F and a pulse rate of 80 after recent travel to India, I was certain of my diagnosis.

It's interesting to speculate on the historical ramifications of President Harrison's death which included, among other things, the annexation of Texas and Mexican-American War. 

So, when asked about the impact of infectious diseases, one can connect a microbe to the Dallas Cowboy Cheerleaders by way of the 1 month presidency of William Henry Harrison. 

Tippecanoe and Tyler Too--that almost sounds like a cheer.

Hoping CBS's Scorpion Will Tackle Infectious Diseases

A rag-tag yet elite group of disillusioned geniuses saving the world (in cooperation with the Department of Homeland Security) is just my kind of story and is the subject of the new CBS drama Scorpion. While I would prefer that they were battling infectious diseases (an idea for a future show?), the first episode focused on cybersecurity issues. However there was one mention of an infectious disease--a tenuous connection, I know.

In one scene, a human calculator character wipes down a diner countertop and states that over 20 diseases can be contracted from chicken. While I never counted the number of chicken-borne diseases, there definitely are a lot of them.

Poultry are naturally carriers of many bacterial pathogens, notably Campylobacter and Salmonella which can cause gastrointestinal illnesses. Cooking chicken thoroughly is enough to kill the bacteria (cook pot pies thoroughly) but cutting boards and counters can become contaminated and cross-contaminate other foods prepared on the same surface.

In my view the most ominous poultry-based infection is, hands-down, avian influenza. This disease, with fatality rates that rival Ebola's, is a clear existential threat that poses a perpetual threat to humanity. Influenza viruses, when adapted to humans, are adept at spreading between humans. Fortunately we have not seen sustained human-to-human transmission of an avian influenza virus, but as many flu viruses have acquired this capacity it is essential to prepare for this eventuality. Currently, infections are centered around individuals who have exposed themselves to the virus in poultry markets and similar settings.

I would love to watch Scorpion's group of geniuses tackle this problem because it is one of the most vexing ones in infectious disease (I know one of its stars, Katharine McPhee, has taken an active interest in another vexing infectious disease: malaria)

Lost in the Ebola & EV-D68 News Cycle: A Promising MERS Vaccine

With Ebola and EV-D68 garnering all the attention, it's not surprising that people have forgotten about MERS. Thankfully, the research community hasn't stopped working to combat this virus that has just gone on a 3-day run of accruing cases in Saudi Arabia.

So, while the world is watching Ebola colleagues at the University of Pittsburgh, led by Dr. Andrea Gambotto, recently published results of a promising vaccine candidate in Vaccine. 

In this study, an adenovirus-MERS recombinant virus (of note, adenovirus-vectored vaccines against Ebola are being studied too), was used in mice and antibodies level measured. The vaccine succesfully provided robust levels of antibodies against the MERS coronavirus, an important correlate of immunity.

What is interesting about this vaccine study is that one of its explicit goals is to create a vaccine that could be used in the animal species responsible for transmitted the MERS virus to humans, presumably camels. It's not an unprecedented idea; we immunize many animal species against rabies and a very select number of humans receive the vaccine. Removing the transmission mechanism of this virus could obviate the need for large scale human vaccination.

It may be difficult to keep up with all the emerging threats and track all the zebras, but we ignore them at our own peril. To echo Dr. Gambotto's statement to the Pittsburgh Post Gazette--"we want to be pre-emptive” against MERS, and all emerging infectious diseases. 

What Has New Orleans to do with Monrovia?

By coincidence today, I finished Dr. Sheri Fink's Five Days at Memorial: Life and Death at a Storm-Ravaged Hospital. In this remarkable book, Dr. Fink--whom I am looking forward to see lecture in Pittsburgh--details the events that occurred at Memorial Hospital during Hurricane Katrina. Specifically, she focuses on the gut-wrenching decisions physicians and nurses had to make as the hospital appeared to become increasingly non-functional and rescue prospects thought to be dim. 

It was in this setting, and without any framework to apply in such an austere situation, that several doctors and nurses found themselves. Faced with the grim choices of which patients could be moved, which couldn't, and in what order to prioritize them decisions were made. As is widely known, allegations of euthanasia surfaced leading to a formal criminal investigation.

To me the theme of the book is that hospitals and other facilities must diligiently prepare for disasters and ensure that during a disaster full situational awareness (e.g. what the true prospects of rescue are, what the conditions are in the entire complex, etc.) is strived for. Also, guidance for physicians that is transparent and widely disseminated--prior to events--must be available for aid in decision-making, especially when conditions call for the rationing of scarce resources. 

Fortunately, since Katrina (and because of it) such a need has been recognized and guidance on Crisis Standards of Care have been developed. 

Now, to put this in today's context, think of how this might apply and is being applied in West Africa. In more than one sense Ebola can be thought of as a hurricane unleaded on the populations of Guinea, Liberia, and Sierra Leone. Bereft of experience in dealing with Ebola--this is their first outbreak--these nations are akin to the doctors in Katrina and, like them, they are confronted with stark choices. 

Who to treat? Who to admit? Who to give IV fluids to? Who to give personal protective equipment to? These are the decisions being contemplated right now in what can only be described as a situation in which extreme crisis standards of care are the norm. 

Reading Dr. Fink's book with the context of Ebola in mind shows how widely applicable her astute observations are.

Emerging Infectious Diseases & Closing the Book on Infectious Diseases

In advance of the expected remarks by the President on Ebola tomorrow during his CDC visit, I have done a few interviews, including this one with NPR, speculating upon what he might propose. 

Whatever is proposed, one thing is certain: this won't be the last time the world faces the threat of an emerging infectious disease.

Reflecting upon this fact I wrote, in Forbes, about how I believe that this and future emerging infectious disease responses should be handled--namely with a high level emerging infectious disease/biosecurity coordinator coupled to a prioritization of the core (i.e. infectious disease) missions of both the CDC and US Surgeon General. 

How wrong was Surgeon General William Stewart when he declared in 1969 that “we can now close the book on infectious diseases." 

Our microbial world guarantees that this book will be open forever but with proper preparation, response and situational awareness we can get it at least shut it partway.