Tuesday, July 12, 2011

Crying Wolf about Infectious Diseases

A well-known public health expert is often asked to be a keynote speaker at infection management seminars. I happened to hear him present at two different infection control gatherings about a year apart. They were both emotional speeches about the modern day dangers cause us all to face. During the first speech he talked about how he lay awake nights worrying about his daughters and their survival chances in a world of anthrax. In the next speech he talked about how he lay awake nights worrying about his daughters and their survival chances in an age of Avian Flu. Clearly he was talking about the disastrous infection of the moment.

So what’s wrong with this picture? Link to the following for the answer: http://2.bp.blogspot.com/_a9OgLbIsBns/TMpEWB-eabI/AAAAAAAAALg/gaQHkVlSf1o/s1600/sky+falling+in+cartoon.jpg.

I believe that the public and healthcare providers are suffering from a disaster fatigue. There are too many infections to worry about them all. Worse yet, many of the dire scenarios painted by the media (with the help of some public health officials) have not occurred. It is becoming more and more difficult to know what is real and what to do about it

At the same time the public has come to view health care facilities as death houses where patients are discharged in worse condition than when they were admitted. Public reporting has reinforced this perception. I think that the fact that reporting is legally required is more frightening than the actual contents of the reports. If it must be reported, it must be really bad.

Certainly, there are serious infections occurring in various places throughout the world. The recent E. coli outbreak was a sobering event. Our job as IPs is to place these events in perspective and to help people understand their personal risks of contracting a serious infectious disease.

When everyone was worried about avian flu I was asked to make several presentations about it. I used humor to try to deflate the audience’s anxiety. I showed pictures of houses built above duck ponds and asked “Does this look like your house?”

I showed pictures of people taking dead geese to market on the backs of mopeds, etc.

I think my efforts were successful in bringing listeners back to reality where they could plan rationally.

The humor was not intended to make light of the issue. Rather it was intended to reduce the level of anxiety in the audience so that we could discuss the actual threats and possible responses.

I think it is important to use a variety of techniques balance the scales of concern. In some cases stories about personal concerns are appropriate. But we must consider ourselves to be Panic Preventionists as well as Infection Preventionists. This is no easy challenge to bring people back to earthly sights when everyone else is screaming “Watch out for the birds”!

The future of the flu vaccine?

Cartoon by Bruce Beattie for the Daytona Beach News-Journal

Flu vaccines today have two major problems: they need to be administered every year, and are only effective against a small subset of flu strains.  Basically, the vaccine makers make an educated guess about which will be the most prominent strains in a given year, and then manufacture the vaccine based on that prediction.  Since different strains become prevalent in different years, this means that each new vaccine must be given when it’s developed each year. 
Damian Ekiert and Ian Wilson, along with Robert Friesen and Jaap Goudsmit from Crucell (a Dutch biopharmaceutical company), recently published a paper in Science Express that details their efforts to prevent and treat influenza infection using antibodies, which would avoid the problems of traditional flu vaccines. 
The project was started several years ago, when Goudsmit and other researchers at Crucell discovered an antibody that bound to a functionally important structure on the flu virus which exists in many different strains.  The antibody, CR6261, worked to both prevent and treat infections by about 50% of influenza viruses, including H1 viruses.  Crucell is about to begin early clinical trials of CR6261, according to the Scripps Research Institute.
To complement this, Crucell’s team began to search for another similar antibody that would be effective against other flu viruses, including H3 and H7 subtypes.  They discovered CR8020, an antibody which binds close to the viral membrane.  CR8020 appears to work by preventing the conformational changes that occur when a flu virus is taken up by a host cell, thereby blocking the release of the virus DNA into the host. 
As Ekiert et al. note in the publication, influenza A viruses responsible for human pandemics have come from very different strains.  In accordance with this, a near-universal therapy for influenza should protect against all these strains, if possible.  Though it is unknown how the antibodies will fare in clinical trials, a mixture of antibodies such as CR6261 and CD8020 is a potentially promising treatment for people who have contracted the flu.  Despite the challenges in developing the antibody mixture into a vaccine, there is now more hope that a “universal” vaccine can be developed.
Infection Control Today article: http://www.infectioncontroltoday.com/news/2011/07/discovery-of-natural-antibody-brings-universal-flu-vaccine-a-step-closer.aspx