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An Infectious Diseases Doctor Views Contagion

1918 Influenza Scrapbook, The College of Physicians of Philadelphia Going to the movies is a time-honored way of getting away from the vagaries of work and home life and inhabiting a different and exotic place. I don’t know if car mechanics can really enjoy chase movies or cowboys can appreciate Westerns, but as a specialist in Infectious Diseases, I rarely get a chance to see someone plying my trade inside the multiplex. There are spoilers ahead, so read on cautiously if you have not yet seen Contagion and plan to go.

The new Steven Soderbergh movie, Contagion, is a fairly realistic guesstimate of what might happen if a highly contagious, new infectious agent started moving around the world and destroying people willy nilly like a marauding tornado. While there has never been an infection quite like “MEV-1” as depicted in Contagion, the question of how we would respond as a medical community and as a society is a worthy one to address. Whether the answer is right or wrong – well, let’s hope we never find out.

From an Infectious Diseases angle, the infection in Contagion is crafted to be highly transmissible and fatal. This would be like a hybrid of the 1918-1919 pandemic flu, Nipah virus and SARS. The end of the movie shows the mechanism via which MEV-1 began to infect humans, and it is highly reminiscent of Nipah and SARS. Thus has some built-in credibility as it builds on diseases that we already understand. It is also eerily reminiscent of the most recent big flu outbreak (A/California/2009 H1N1) where the virus contained elements that came from birds, pigs and people. The rapidity of spread lends the movie much of its terror, but is not far off the rapidity of spread of influenza. Similarly, the incubation period and time to death is also reminiscent of the 1918-1919 pandemic flu. So the film-makers have done their homework and created a plausible disaster scenario. More

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Vaccine Meetings Discuss Challenges, Achievements

Two important vaccine meetings were held September 11 and 12 at The College of Physicians of Philadelphia. The September 12 meeting entitled Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies was sponsored by the Department of Health and Human Services, the Office of Research Integrity, Drexel University, University of Pennsylvania Center for Bioethics, and The College of Physicians of Philadelphia. Speakers focused on vaccine development and distribution for biological threats and how the emergency preparedness experiences with A/H1N1 provided lessons that might inform future preparation for similar public health emergencies. More

Philadelphia Vaccine Meetings 9/12 and 9/13

The College of Physicians of Philadelphia Two important vaccine meetings are being held at The College of Physicians of Philadelphia. The first meeting occurs September 12, and is entitled Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies. Sponsors include the Department of Health and Human Services, the Office of Research Integrity, Drexel University, University of Pennsylvania Center for Bioethics, and The College of Physicians of Philadelphia. The second meeting on September 13 is part of the National Vaccine Program Office's effort to gather stakeholder input. Regional stakeholders are invited to attend sessions and share their experiences with immunization, particularly around racial and ethnic disparities, risk communications, and adolescent and adult vaccines. The information gathered at this meeting will help guide the implementation of the National Vaccine Plan as well as inform local and regional vaccine groups on barriers and successes in immunization. More

FDA Approves Tetanus, Diphtheria, Pertussis Booster For Adults 65+

This photomicrograph shows Bordetella pertussis bacteria using Gram stain technique. Credit: CDC. In October 2010, the Advisory Committee on Immunization Practices (ACIP) issued a new recommendation for Tdap vaccination -- the booster vaccine that provides protection against tetanus, diphtheria, and pertussis (whooping cough). While the vaccine had previously been recommended as a one-time booster for adults up to age 64, replacing an individual tetanus booster, the committee voted to expand that recommendation: anyone older than 65 who had not received a prior dose of Tdap should receive one if they expected to have close contact with an infant younger than 12 months old.

This recommendation was made partially in light of the California whooping cough epidemic. While whooping cough is typically less severe in adults, the infection can still be passed to infants, for whom infections are much more severe. Study data has indicated that grandparents, for example, are the ultimate source of the infection in 6-8% of cases. However, the committee noted that there was a direct benefit to the individual as well, since whooping cough tends to be more severe in adults older than 65 than in younger adults. (For more details, see "Advisory Committee Votes for Expanded Pertussis Vaccine Recommendations" from the History of Vaccines blog.)

Although this recommendation was issued last October, some adults older than 65 who wanted to receive a Tdap booster had difficulties obtaining one due to confusion between the ACIP's recommendation and the FDA's approved label usage for the vaccine at the time. Neither of the two Tdap vaccines (Sanofi Pasteur's Adacel and GlaxoSmithKline's Boostrix) was approved by the FDA for use in adults older than 65. More

Pacific Health Summit: June 21-23

HOV at Pacific Health Summit Just a week after a June 13 summit at which public and private donors committed $4.3 billion to continue funding the GAVI Alliance’s efforts to immunize the world’s poorest children, another vaccines summit played out in Seattle. The Pacific Health Summit, a yearly conference examining a different global health issue, convened June 21-23 with the goal of connecting decision makers in science, industry, policy, and public health to improve health by combining the latest in scientific advances with industrial innovation and effective policy. Past topics have included multi-drug resistant tuberculosis, maternal and child health, malnutrition, and pandemic influenza. More

Meningococcal Vaccine Showing Early Promise in Africa

Scanning electron microscope image of Neisseria meningitidis, 3,750x. Copyright Dennis Kunkel Microscopy, Inc. Last December, the History of Vaccines blog covered the introduction of MenAfriVac to the African meningitis belt, an area stretching from Senegal to Ethiopia, where epidemic waves of meningitis occur and can last up to three years. In the largest of these epidemic waves in history, meningitis killed more than 25,000 people from 1996 to 1997.

Polysaccharide vaccines are sometimes used to try to control outbreaks after they have begun: so-called “emergency vaccination” efforts designed to keep meningococcal epidemics from spreading further. However, these types of reactive efforts are very expensive and difficult to manage, and polysaccharide vaccines do not induce long-lasting immunity against meningococcal bacteria. (For more about the different types of vaccines, see our article and Types of Vaccines activity.)

Within these African epidemics, between 80 and 85% of cases are caused by a single group of meningococcal bacteria: group A. In 2000, a group of global health leaders gathered together by the World Health Organization (WHO) determined that a meningitis vaccine could be developed specifically for use in Africa: a low-cost vaccine that would focus solely on the Group A bacteria. The Bill & Melinda Gates Foundation provided a ten-year grant for what would become the Meningitis Vaccine Project (MVP). More

'No Bones About It' Features HoV Guest Speaker Michael Willrich

Michael Willrich addresses a crowd of about 100 at the College of Physicians. The latest episode of "No Bones About It," The College of Physicians of Philadelphia's popular YouTube series, features historian Michael Willrich. Willrich recently spoke at the College for a well-attended History of Vaccines event and discussed his most recent book, POX: An American History, which chronicles the smallpox outbreaks at the turn of the 20th century. Before the event, he sat down with Robert Hicks, director of the Mütter Museum and the College's Historical Medical Library, and the host of "No Bones About It." In this episode, Hicks and Willrich discuss compulsory vaccination, the intersection between civil liberties and public health, and the beginnings of the American anti-vaccination movements in the late 19th century. More

National Infant Immunization Week: Spotlight on Measles

U.S. measles cases dropped rapidly after vaccine use became widespread in the 1960s. (Click for full size.) National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog features posts about several diseases that can be prevented by vaccination of infants.

Rubeola, or measles (as it's more commonly known) is an extremely contagious viral disease. It causes a distinctive rash, fever that can reach 104°F or higher, runny nose, and cough, and has many potential complications including ear infection (in about 10% of cases) and pneumonia (about 5% of cases). In about one in a thousand cases, the patient develops encephalitis, a swelling of the brain. About one out of every thousand patients will die.

The rubeola virus spreads easily and rapidly via coughs and sneezes, and remains active and infectious in the air for up to two hours. As a result, a person can become infected just by breathing the air in a room that was occupied by a measles patient as much as two hours earlier. There is no treatment for the disease, although supportive care may be provided, and efforts may be made to lower the patient's fever. More

National Infant Immunization Week: Spotlight on Rotavirus and Pertussis

Transmission electron micrograph of intact rotavirus particles. National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog features posts about several diseases that can be prevented by vaccination of infants.

Although its name is not as well known as those of diseases like chickenpox or measles, rotavirus is the most common cause of severe diarrhea in children and infants worldwide. Before a vaccine was introduced in the United States, the disease caused more than 400,000 doctor's visits and 200,000 emergency room visits each year, causing as many as 60 deaths annually in U.S. children younger than five.

The virus spreads easily among children, and can also be passed from children to those with whom they're in close contact. Rotavirus spreads via the fecal-oral route -- that is, from the waste of an infected person to the mouth of another individual. This can occur via contamination on hands or objects like toys.

Rotavirus can be prevented by vaccination. The first dose of the vaccine series is recommended at two months of age. More

National Infant Immunization Week: Spotlight on Diphtheria

Diphtheria is still endemic in these countries. (Click on the image to view it at full size.) National Infant Immunization Week is April 23-30 this year. This week, the History of Vaccines blog will feature posts about several diseases that can be prevented by vaccination of infants.

Diphtheria, now nearly unknown in the United States, was once a common childhood affliction. In 1921 the country recorded more than 200,000 cases and more than 15,000 deaths, with the highest percentage of fatal cases among children younger than five. Although the last recorded case in the United States was in 2003, diphtheria remains endemic in many countries.

The disease is caused by a bacterium, Corynebacterium diphtheria, although the actual damage is not done by the bacterium itself. Instead, it secretes a toxin that damages the body's tissues. The most unique symptom of diphtheria is a thick gray substance that can spread over the nasal tissues, tonsils, larynx, and/or pharynx. This substance, called a pseudomembrane, can block the airways; in fact, diphtheria was known in Spain as "el garatillo" -- "the strangler." The toxin produced by the bacterium can also travel through the bloodsteam and damage other organs. More