The recent measles outbreak in the United States with 121 reported cases (as of February 12th, 2015) along with the continuing spread is extremely alarming. Whether or not to have mandatory vaccination requirements should not be a debate when there have been constant affirmations from the scientific community about the safety and efficacy of vaccines. Parents who believe it is in their children’s best interest not to vaccinate refuse to recognize the importance of herd immunity. This troubling trend in ignorance and denial of science is endangering thousands of lives. The war between science and anti-science is not a new one. Personal beliefs towards evolution, climate change, GMOs, and vaccinations should not dictate public health and safety. The current war against vaccinations is the most dangerous one because of its immediate threat as compared to the long-term perils of climate change or GMOs.
A recent vaccine discussion on Real Time with Bill Maher was troubling to watch due to the many misguided and misinformed comments that were casually thrown across by the panelists. The ignorance of Maher and his guests was exposed when comparisons were drawn between the safety of vaccines and climate change, antibiotics, and Monsanto. One panelist said, “The implication is that if you have any skepticism whatsoever, you are anti-science..and I think there is a difference between having skepticism against science and having skepticism against the pharmaceutical industry.” – This is an interesting point as well as an important one. Having mistrust over pharmaceutical industries should not prevent the parents from vaccinating their children. Questioning the ethics of large pharma corporations should not overshadow the larger issue that is public protection and immunity. Maher continued to compare vaccines with antibiotics, and the highlighted the concern regarding antibiotic resistance. These are different modes of treatments used in different situations. Trying to deduce the reasoning and thought process of the guests in this 12 minute conversation was just frustrating. Maher’s comment, “I’m not so sure that people who get a lot of them (vaccines) have as robust an immune system” proves that he is misinformed about the science just like many others. This is one of the many debates that exposes the gap between what the scientists know and what the public perceives.
Politicizing scientific truths seems to be the highlight of the decade. Skepticism is healthy and favored for the advancement of science and medicine. However, skepticism should not overshadow evidence and accuracy. Media and other outlets have the responsibility of communicating science with all its truthfulness. With a decline in trust and credibility of various media outlets, it is on us to bridge the gap between scientific reasoning and the rising anti-science brigade.
Earlier this month, the CDC officially announced the first confirmed case of MERS coronavirus in the United States. Interestingly, the virus was identified in a man who flew from Saudi Arabia to Chicago, and then traveled to Indiana – where he reported symptoms such as fever and cough at a Community Hospital in Munster, Indiana – not very far from where I stay. I have taken one of these buses to get to the airport in Chicago many times before. After having written about the transmission of the virus a few months back, and after having diligently kept track of its spread across the globe, I was amused when it ended up a few miles away from me (of all places!).
Another coincidence is that I was asked about the scientific accuracy of the transmission of MERS-CoV along the lines of the movie Contagion – in which a single infection of Nipah virus leads to a pandemic within weeks. Interestingly, Nathan Wolfe (about whom I wrote previously) was the ‘virus advisor’/consultant for the movie!
These are some really unusual coincidences that interconnected with my flow of thoughts and makes things very interesting while following up with the news from the world of popular science.
Up until now, discovering new viruses was limited to recognizing the symptoms caused by their infections in humans and other animals. Dr. Nathan Wolfe and his team of researchers have reinvented the process of hunting down new, unknown, deadly viruses before they spillover to other animal hosts, including humans. Along with the native hunters, these scientists walk through the deep jungles of central Africa (home to the majority of emerging viruses and reservoir animals), collecting blood samples from primates, snakes, rodents (bush meat for the natives) in order to identify the unknown pathogens.
According to recent statistics, about 75% of the newly emerging diseases are zoonotic (i.e., of animal origin), out of which are a majority of human viruses like Rabies, SARS, Ebola, HIV, Influenza. This calls for a review of our previous and current system of identification and prevention of new pathogens. This process requires collaborators to head to the source, undertake the legwork, and prep the region locals by educating them about the risks and dangers involved in their day-to-day encounters with deadly viruses.
I was introduced to Nathan Wolfe’s work in my Virology class last semester and his TED talk remains to be one of the most inspiring (and one of my favorite) talks. It struck a chord in the sense that it made me realize that biological science research isn’t limited to working in the laboratory, and sometimes involves getting out there in the field to change the course of actions. In Dr. Wolfe’s words, “We may have charted all the continents on the planet, and we may have discovered all the mammals, but that doesn’t mean that there’s nothing left to explore on Earth.“
Recently, two new oral drugs were considered for approval for Hepatitis C – a viral infection caused by Hepatitis C Virus (HCV) that affects liver cells and ultimately causes liver failure and/ or hepatocellular carcinoma due to chronic condition. One may not have heard much about the Hep C disease, but it is more common than HIV. WHO has estimated that around 150 million people around the world are chronically infected with HCV and more than 350,000 people die every year from Hep C related liver diseases. So far, smallpox is the only viral disease of humans that has been completely eradicated from the planet due to the success of vaccination strategies using live attenuated vaccinia viruses. No vaccine is available against HCV owing to the high mutation rates of it’s positive single stranded RNA genome.
Current treatment for Hep C involves injecting interferon- a class of cytokines which induces an antiviral state in the infected cells and enhances the immune system. It is given in combination with ribavirin, which is a nucleoside analog. Being a prodrug, ribavirin is activated inside the cell and inhibits viral replication by interfering with viral RNA synthesis and viral mRNA capping. However, simeprevir and sofosbuvir – the newly approved oral medications, are meant to directly interfere with HCV’s ability to replicate and make proteins when taken along with ribavirin. In a phase II trial, about 78% of patients infected with HCV were cured with a combination of sofosbuvir and ribavirin without the need of interferon. This is not a new strategy when it comes to antiviral drug treatments. Similar kinds of “drug cocktails” are used to treat HIV infection as a part of Highly Active Antiretroviral Treatment therapy.
In an interview with Nature, pharmacologist Raymond Schinazi of Emory University said “This is the first time in the history of humankind that we have a cure for a viral disease”. This statement may seem too far fetched considering the nature of the virus and it’s ability to reside in the cells for many years causing no external symptoms. Also, there is always the case of emergence of drug resistant strains due to highly mutable viral genomes. Antiviral drug treatment studies take extremely long periods of time to evaluate the outcome across the globe. However, an advantage for HCV treatment efforts is that the virus has no animal reservoirs and is transmitted between people only through contaminated blood. Increased and improved blood screening techniques can prevent transmission of the virus among populations.
A couple of days back, I briefly spoke about the theories surrounding the origin of MERS-coronavirus on twitter and got interesting responses like “Batman!” during the discussion. (Let us not eliminate this possibility entirely, okay?) Middle Eastern Respiratory Syndrome, which was first reported in Saudi Arabia in September 2012 1, is similar to SARS, and causes severe respiratory illness with symptoms of cough, fever, and shortness of breath including acute renal failure which ultimately results in death of the infected individuals in fifty percent of the cases. So far, 150 cases have been reported by CDC 2, which include 64 deaths (most affected countries being Saudi Arabia, United Arab Emirates, Jordan and Qatar). What’s interesting is the quest to find the origin of the virus and it’s mode of transmission.
Since most viruses are harbored and transmitted by animals, a team of scientists first suspected the most plausible animal in the Middle-East that could’ve sheltered this virus – camels! Antibodies against MERS-CoV (and not the virus itself) were found in some retired racing camels in Oman 3. The specificity of the antibodies against MERS were tested positive in every single camel but none of the animals had antibodies against SARS. These false positive results further raises questions about camels being the original animal reservoir of the virus .
Bats are the next key suspect because viruses related to MERS are found in several bats species. More specifically, SARS-CoV comes from bats. These mammals are also the reservoir for Nipah virus, Hendra virus, Rabies virus, Ebola virus, and Marburg virus – all of which belong to other families. Not surprisingly, Columbia University virologist Dr. W Ian Lipkin found a 187-nucleotide RNA fragment in the feces of an Egyptian tomb bat that exactly matched the corresponding sequence in MERS-CoV 4 that was isolated from one of the victims. A possible theory is that humans may have been infected with the virus by coming in contact with bats’ feces during encroachment of old abandoned buildings, which serve as a natural habitat for tomb bats. However, Dr. Lipkin does not think that the bats could’ve infected humans directly 5. Here’s where the camels from Oman come into picture, by acting as an intermediate host for the virus. The virus could’ve been transmitted to camels through the bats’ droppings. Humans and camels posses a close relationship in the Middle-East where the animals of burden, used for their meat and milk, are imported from other countries. An alternate possible explanation is that the virus might have originated in bats from one of these countries, hitchhiked on the exported camels and spread in the Middle-East.
Given only the small sampling of camels and bats in these countries so far, one can speculate the existence of other hosts for the virus. Perhaps there are other missing links in the chain of transmission. Other bats & wildlife species and domestic animals for CoV infection, and their link to humans must be investigated. It is a situation of race against time for scientists when a new virus emerges faster than our understanding.
Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. 2012. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. The New England Journal of Medicine. 367: 1814 – 1820
MERS webpage on CDC – http://www.cdc.gov/coronavirus/mers/
PubMed Health News Article – http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2013-08-09-camels-may-be-source-of-mers-virus-transmission/
Memish ZA, Mishra N, Olival KJ, Fagbo SF, Kapoor V, Epstein JH, et al. Middle East respiratory syndrome coronavirus in bats, Saudi Arabia. Emerging Infectious Diseases. Vol 19. November 2013
Dr. Ian Lipkin for Science – http://news.sciencemag.org/health/2013/08/bat-out-hell-egyptian-tomb-bat-may-harbor-mers-virus