Jonas Salk: An Original Scorpion Team Member

Last night on the CBS show Scorpion one of Pittsburgh's most esteemed former residents was mentioned: Dr. Jonas Salk.  For those who don't know, Scorpion is a show about a team of geniuses that assists the Department of Homeland Security with special problem--a premise I find fascinating.

The context of the Jonas Salk mention was regarding the strategies needed to tackle difficult problems. Specifically, when Salk was solving the problem of the polio vaccine he battened down and thought through the problem and didn't just wish that things would go his way. This is the admonition to  never putting anything above the facts of reality, or as Ayn Rand succinctly put it, never put an "I wish" above an "it is"--something that physicians and scientists, especially, must never forget. 

Being from Pittsburgh, Jonas Salk has a special resonance with me. I have heard countless stories from people who knew or met him and I'm a bit jealous of their opportunity. Walking around Pittsburgh, being an odd person, I sometimes think about what it would be like to see him walking down the road, getting a slice of pizza, or other things that I do in Pittsburgh every day. In the book Splendid Solution: Jonas Salk and the Conquest of Polio--which I highly recommend--it details his almost ritual lunch at a now long gone Chinese restaurant where The Pittsburgh Press (also long gone) science reporter John Troan would try to get an indication of what was transpiring with the polio vaccine work that ultimately changed the face of this dread disease. 

One scene in particular really grips me. After the resounding success of the clinical trial of the vaccine was announced in Michigan, Dr. Salk returned to Pittsburgh and was greeted by throngs of people expressing their thanks for he and his team's achievement. His motorcade had a police escort. Imagining Dr. Salk receiving the fanfare almost exclusively reserved for the Pittsburgh Penguins, Pittsburgh Steelers, and the Pittsburgh Pirates is kind of exhilarating and I can almost experience the sense of justice and Pittsburgh pride that must have electrified the air on that day.

I am glad that Scorpion, a show whose theme I believe revolves around the crucial survival value of intelligence saw fit to pay homage to one of the real life examples that concretizes the veracity of its theme. 

Athlete's Foot Shares the Wealth with Mumps in Locker Rooms

Everything comes to Pittsburgh after it comes to New York: cool hamburger bars, hipsters, boutique hotels, and mumps. Headlines in Pittsburgh today are detailing Penguin captain and superstar Sidney Crosby's bout with this relatively benign disease that causes characteristic salivary gland enlargement.

As a good proportion of the population has grown up during the post-mumps vaccine era--which began in 1949--there is concern about its reappearance and the risk it confers. What bears emphasis is that mumps is not one of the horseman of the apocalypse, even if it is capable of sidelining several hockey players. As I have written before, severe complications of mumps, such as meningitis, are rare, more common in adults, and recovered from uneventfully (even those who experience meningitis).

Mumps resurgences are due to waning immunity coupled with the exposure pressure inherent in closed populations such as college dormitories or hockey locker rooms. While even I probably have waning immunity to mumps, I don't have much exposure pressure and certainly am not party to "saliva spray". As such, mumps doesn't represent a significant public health threat at this time.

The diagnosis of mumps, a nationally notifiable disease, is usually based upon seeing the classic facial appearance. Confirmation is made either by looking for antibodies to the virus, growing the virus, or detecting the genetic material of the virus. Antibody tests may be hard to interpret in a previously vaccinated person who has a breakthrough infection and may be falsely negative (as seems to be the case with Crosby); other tests may prove more useful in that setting.

Another concern is the contagiousness of mumps. While it is a minor illness, it is important to try and delimit spread. Mumps is spread through direct contact with respiratory secretions and people are contagious 2 days prior and 5 days after salivary gland swelling. I can imagine a hockey player locker room being strewn with snot, spit, and other secretions--a perfect playground for mumps.

The case in Pittsburgh has caused some added concern because another Penguin being investigated for mumps visited a hospital. Since mumps is not airborne, it is not clear that a major risk of transmission existed and even if significant exposures occurred, the consequences, if any, will be minimal as vaccination uptake is high amongst the population.

Though I enjoy it when there's general interest in any infectious disease, a recalibration of threat perception is needed: we are likely in for a rough flu season and that is of much greater concern than hockey player's faces morphing into those of chipmunks.

Heroes Sabotage Nazis with Fake Typhus Vaccine: It Really Happened

I imagine it's hard enough to be a scientist in the best of conditions because it amounts to exacting work demanding complete focus. I think it is almost unfathomable to perform such work in less than ideal situations, let alone war torn nations or dictatorships. The latter is the setting of The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis by Arthur Allen. 

This book tells two stories: one about typhus and the other about the scientists plight under Nazi rule. 

There are a few facts about typhus that I think everyone should know:

• It is a disease known since antiquity
• It is spread through body lice
• It can wreak destruction in populations that don't wash their clothes regularly -- just ask Napoleon
• Countermeasures against typhus were a priority for the military in the pre-antibiotic era

Given this context, you can see how typhus vaccine---invented by Rudolf Weigl--would attract the attention of the Germany military during WWII. 

The enormous benefit and ingenuity needed to make the vaccine isn't the most remarkable part of the book however. What I found most remarkable was that during the Nazi occupation of Poland, when the laboratories were under strict Nazi control,  heroic scientists thought to sabotage the Nazis by giving inert control vaccine to the Nazis while giving real vaccine to those in the Jewish ghettos. 

Such acts really give concrete form to the definition of hero, formulated by philosopher Andrew Bernstein, as "the man who lets no obstacle prevent him from pursuing the values he has chosen."

Flu Vaccine Mismatch: Maybe Use Match.com or eHarmony Next Time?

Yesterday the CDC released an alert that described an unfortunate phenomenon that has occurred with this year's flu season: a vaccine mismatch. This is not a surprising development as mismatches are known to happen as predicting flu strains can be very difficult given flu's ability to shift and drift.  But when such mismatches occur they can be expected to diminish the 60% effectiveness of the vaccine.

What happened this year was that the H3N2 strain included in the vaccine does not match over half of the H3N2 strains isolated thus far. If H3N2 strains were only predicted to be a minor part of this year's flu season this fact might not much a difference, but it looks like we might be in for an H3N2 dominant season so this could become very significant. In general, H3N2 seasons tend to be more severe than those dominated by other strains so we may be in for a rough winter.

The mismatched strain, which first appeared in March 2014, has already been slated for inclusion in the upcoming vaccine for the Southern Hemisphere, whose flu season is the mirror image of the Northern Hemisphere's season. But, given the lead time needed to make flu vaccines, it's not something that could have been incorporated into this season's Northern Hemisphere vaccine.  

It's important to remember that, despite the mismatch, the flu vaccine is something that everyone should still received as this mismatch is only for 1 of 4 strains and the other strains will certainly cause disease this season. 

The only way to eliminate the chances of future mismatches is the development of a universal flu vaccine that targets a part of the virus that does not change. That would be a true game changer. 

Hockey Players with Swollen Faces: Puck, Fist, or Mumps?

Professional sports teams, because of the close contact amongst players, are always ripe for outbreaks of contagious diseases. In the recent past MRSA has been one organism associated with sports-related outbreaks (see the St. Louis Rams).  Today, the NHL is now facing an outbreak of mumps that has plagued several teams. 

Mumps is a viral disease and is generally preventable through vaccination. It is one of the "M's" in the MMR vaccination. This vaccine, like many others, is due to the genius of Maurice Hilleman--one of the true heroes of infectious disease. It is known for causing characteristic swelling of the salivary glands but can also meningitis or orchitis (inflammation of the testicles).

However, over the past several years we've seen large outbreaks of mumps occur in certain population that are somewhat dense such as amongst college students. Interestingly, these outbreaks are occurring in relatively highly vaccinated groups of individuals (vs. measles, for example). 

So why are these outbreaks occurring? When a vaccine fails I think of one of two causes: the pathogen has mutated or the immunity induced by the vaccine has fallen below a protective threshold. While the strains causing these outbreaks (G) is different than the vaccine strain (A), G strain outbreaks are halted by the A strain vaccine. So strain disparity doesn't seem to be the explanation. There has been some suggestion that a third booster dose of the vaccine can bring outbreaks to a halt supporting the waning immunity theory.

Another factor is something called "exposure pressure." Since these outbreaks are occurring in specific "closed" populations could it be that the amount of exposure an adequately vaccinated individual has to the virus in these outbreak settings overwhelms the immune system?

My hypothesis is that it is probably waning immunity coupled to exposure pressure that explains these outbreaks. Outside of outbreak settings mumps has become much less common and any natural boosting of vaccine immunity from exposure to natural cases is no longer present, allowing antibody levels to fall. Those with waning immunity are simply unable to resist the virus when faced with the exposure pressure in a closed population in which mumps is being harbored.

There are reports that some teams are moving forward with booster doses, which should stem the outbreak. But, it remains important to understand more fully why these outbreaks continue to occur and whether universal 3rd boosters should be considered for certain populations.