Anthrax Shipments: Can't Keep a Good Spore Down

The eagerly anticipated release of the US Department of Defense's report on the inadvertent live anthrax shipments that originated from Dugway Proving Grounds contains a lot of important information but--as expected--no smoking gun or scandal. 

The biggest takeaway from the report, to me, is that anthrax has evolved to become a very hardy organism with spores that are very resistant to being killed, even withstanding some irradiation procedures. This is not too surprising given what the entire function of a bacterial spores is: to protect the bacterium from harsh environmental and nutritional conditions. 

The issue with the mistaken shipments, in my view, is not that live anthrax was transferred between labs but that the recipients and senders did not know that the anthrax was live (which is indicated by a special sticker on the package).

The report contains several important recommendations to prevent such an occurrence from happening in the future. The DoD panel contained experts who offered well-reasoned analysis  derived from a comprehensive examination of the facts and science.

However, from many of the media interviews I did on the topic, the general public and lay press do not have a great understanding of the topic and harbor many misconceptions about anthrax. Several facts that I had to repeat many times included:

• The fact that anthrax is not contagious.
• The realization that anthrax is a worldwide natural disease, not just a biowarfare concern.
• Live anthrax research occurs in specific labs.
• Infectious pathogens are mailed from lab-to-lab on a regular basis, including live anthrax.
• There is effective post-exposure prophylaxis for anthrax (vaccine and antibiotics).
• That defensive research on anthrax, which is vital, is not a violation of the Biological Weapons Convention.

It's been 14 years since the US was in the midst of an anthrax attack and it is understandable that the level of knowledge of this microbe has waned, however it remains a threat and research on preparedness is crucial--points that are worth repeating as many times as necessary.

A New Arrow in the Pro-vaccine Quiver: Eula Biss's On Immunity

I'm often accused of not seeing the other side of the vaccine "debate". I think that's a fair description of me, but it's for a good reason--there is no other side. However, it is understandable that a lay person inundated with multiple layers of misinformation may be honestly mistaken and fall prey to the anti-vaccine movement. Once in the clutches of the movement, it can be hard to reach such people. For example, the standard vaccine books often do not make any headway against what is, for many, a largely emotional conclusion against the power of vaccines. As such, many physicians feel resigned to accept that some people are unable to be swayed. However, there is a new tool available.

Eula Biss's On Immunity: An Inoculation is a remarkable book that I believe will fill an important niche in the defense of vaccines and has the potential of persuading those who doubt the benefit of vaccines to re-examine their conclusions. The book is a journey through the honest deliberations Ms. Biss herself undertook with the birth of her son. Rightly concerned with her newborn's safety and protecting him from harm (like the mother of Achilles--see the cover art), Ms. Biss's diligence to unpack arguments for and against vaccines is instructive as it shows how an active mind approaches complex issues and weighs the testimony and work of experts--an important trait that extends beyond vaccines.

 The comparative advantage and immense value of Ms. Biss's book is that it offers the reader a glimpse of how a non-medical individual approaches the issue of vaccination, what context of knowledge is activated, and how risk is assessed. In all of these realms, Ms. Biss excels and provides ample data (as well as expertly chosen anecdotes) to concretize the important points she makes throughout. 

Doing battle with those who would return us to the primitive with their opposition to vaccines--an unmitigated triumph of technology--will be a little easier with Ms. Biss at our side. I highly recommend her book.

Squirrels Packing Real Viral Heat, Not Just Nuts

Virtually no one thinks of squirrels as anything more than cute spastic creatures that are fun to watch. All animals harbor dangerous infectious disease that--in specific contexts--can pose a risk to humans. Accordingly, it has been well-established that squirrels are connected, via their lice, mites, and fleas, with plague, certain forms of typhus, and rickettsialpox (for example). 

A newly discovered virus (likely directly transmitted from squirrels) can now be added to these indirectly transmitted infections: variegated squirrel 1 bornavirus (VSBV-1).

What is interesting about this newly discovered fatal encephalitis-causing virus is that it appeared in 3 German squirrel breeders and how it was identified. 

Anyone who operates at the interface of humans and animals should be considered a sentinel or a canary in the coal mine for novel infections. Most human infections originated from animals and jumped into the human species at some point, so it is likely that animals will remain a major source of new infections. Such a fact underscores how important it is to be extremely vigilant when dealing with an unexplained illness in individuals who have unusual animal exposures and never being satisfied until an actual etiology has been established--something that happens all to rarely.

Additionally, the identification of this virus employed a metagenomic approach in which sequencing of nucleic acid was performed directly on squirrel samples with the aim of finding genetic material that could be linked a known microbe family. 

The paper is, to me, significant not just for the description of VSBV-1 but for highlighting the importance of viral discovery and the principles that should be applied. 

Thank You Louis Pasteur

Yesterday was the 130th anniversary of Louis Pasteur's rabies vaccination of Joseph Meister--a day that everyone should recognize and celebrate. Though Jenner's smallpox was the first vaccine and Pasteur's called his rabies version "vaccine" to honor Jenner, Pasteur--in my view--is on the highest echelon of our race. 

Why I elevate Pasteur to that level has to do with the fact that not only did he discover the rabies vaccine but his contributions to the germ theory of disease (I'm not even counting  his contributions to stereochemistry) gave the entire field a green light to hypothesize, innovate, and advance. Such an achievement's ramifications are incalculable. 

To put it simply, I just would like to say thank you to Louis Pasteur for his recalcitrant, intransigent pursuit of the truth and that I am embarrassed that some members of our species have returned to the primitive status that humans have wallowed in for most of our history by shunning vaccination and pasteurization. 

The debt we owe Pasteur is not something repayable. 

Measles Still Has A License to Kill

The news of the 1st acute measles death in the US in over a decade is an event that should serve to remind those who doubt the ability of this virus, which kills 145,000 people per year, to inflict damage in the developed world. However, I doubt it because if people can blow off the 20% hospitalization rate that occurred during the Disneyland outbreak, one immunosuppressed person's death isn't enough to crack through layers of evasion.

I am interested to learn the details of this unfortunate case that resulted in a fatal measles pneumonia to see how the diagnosis was made, when it was made, and what confounding variables were present (I know no rash was present, something that occurs in the immunocompromised).

To date there have been 178 cases of measles reported this year, with nearly half of the 50 states being affected. The numbers are largely driven by the Disneyland outbreak that began last year.

Letting our guard down against this plague carries dire consequences.