Ebola Does Dallas

So it looks like the inevitable--based on the sheer size of the outbreak and travel patterns-- happened, an infected non-healthcare worker from Liberia was diagnosed with Ebola in Dallas. While the details are sketchy at this point this case illustrates the extreme importance of asking a travel history in patients who may have been in Ebola-stricken areas. This patient departed Liberia on September 19 arrived in the US on September 20 and was not experiencing symptoms--and thus not contagious--until a few days later, on September 24. Interestingly, the patient first presented for care on September 26 but was not admitted to the hospital on September 28. 

This case, like any Ebola case, can be treated in an ordinary hospital and need not require a containment facility (as the four evacuated patients have been placed in). I, for one, hope that this case is taken care of in the "ordinary" setting of Texas Presbyterian Hospital to illustrate how non-contagious Ebola patients are when cared for using appropriate personal protective equipment.

Another thing to remember is that the US has adeptly handled imported cases of Lassa Fever and, Ebola family member, Marburg multiple times in the past. To quote CDC Director, Dr. Tom Frieden: "There is no doubt in my mind that we'll stop it here."

Ebola will not find the US as hospitable a place as Debbie did Dallas.

Scorpion Grants My Wish: An Infectious Disease Episode

Last week I hoped Scorpion, the new CBS show about a team of geniuses that assists the Department of Homeland Security, would focus on an infectious diseases as well as other problems. Well, this week they granted my wish and they were immersed in responding to a pathogen, related to the common cold virus, synthesized specifically to infect the California governor's daughter and a few others.

What the Scorpion team was facing was a biohacker who employed synthetic biology for a sinister purpose. Synthetic biology, the realm of biology that deals with the creation of novel genetic sequences, holds tremendous promise for curing disease, specifically targeting therapy as part of personalized medicine, and revolutionizing biotechnology. 

However, just like almost every trade, there are dual-use concerns with the rise of synthetic biology, the biohacker movement, and DIY biology. I share some of these concerns but have an overriding fundamental belief that all these developments are essentially good and representative a major advice for mankind. 

While the show requiring some suspension of disbelief--an antidote was made in two hours--it is good to see these issues penetrating into popular culture.

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.