Have No Fear. Therapy is Here.

The topic of this week’s blog is on the two-faced, backstabbing diseases of the microbiology world. What are these treacherous diseases you ask? Well, they are none other than autoimmune diseases. As the name suggests, these diseases occur when immune cells begin to attack host tissues they are supposed to be protecting. Rude. This is where the backstabbing reputation comes from. You expect your immune cells to protect be there for you through thick and thin, but instead they attack you. You wonder who will be there for you; who can you trust?

Have no fear, therapy is here! Therapy is our knight in shining armor when it comes to saving us from the evil autoimmune diseases. Earlier I gave a very generalized description of an autoimmune disease. I think it’s important to give a little more background on what kinds of diseases can arise before diving into how therapy can be used. According to the American Autoimmune Related Disease Association, there are more than 100 autoimmune diseases, so I will not be discussing all of them. Among the numerous autoimmune diseases are Lupus, Narcolepsy, Psoriasis, and cancers. It is reported that about 75 percent of autoimmune disease cases occur in women. What’s so scary about these types of diseases is that the cause is sometimes not fully understood. However, it is thought that some cases are triggered by exposure to microorganisms in people who have a genetic predisposition to the disorder. Now that you have a better idea on what an autoimmune disease is, we can look at what we can do to treat them.

This article discusses both current practices and future prospects for treating autoimmune diseases. Most traditional therapies rely on immunosuppressive medications that aim to dampen immune responses. These have shown great promise in helping patients and are the current chosen option of care when it comes to treating autoimmune diseases. Unfortunately, when these medications are used for long periods of time, high doses are needed to maintain disease control. This can cause the patient to become vulnerable to other deadly opportunistic infections. Since this type of therapy can have serious consequences there has been a push for development of new therapies to treat autoimmune diseases with lower risk of other infections.

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One of the new wave treatments is a costimulatory blockade. This type of therapy deals with the activation of T cells. T cells require two main signals in order to become activated. The first signal is antigen recognition through a T cell receptor by major histocompatibilty complex (MHC) molecules on antigen presenting cells (APC). The second signal is a costimulatory signal where ligand B7 on APC interacts with the CD28 receptor on T cells. Both of these signals are needed to achieve full activation, so if one of these signals is not present then the cell will become anergic. This means there will be a lack of immunity to that specific antigen. By blocking this costimulatory pathway we can inhibit the activation of auto-reactive T cells in patients with autoimmunity and voilà! We have a new therapy to treat autoimmune diseases.

Thimerosal: A Tragic Life

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Thimerosal was brought into this world in the 1930’s. It was a promising young ingredient used in many vaccines, but tragedy struck in 2001 when it was removed from children’s vaccines. *Sheds tear* According to the CDC, thimerosal is a mercury-containing preservative, but the important thing to note here is not all types of mercury are the same. Simply put, some are harmful and some are perfectly safe. However, that did not stop people from latching onto the bad connotation of the word “mercury” and assuming that thimerosal was making them sick. The mercury in thimerosal does not stay in the human body, so it’s unlikely that it would cause illness. The CDC also reports there have been many studies done on the use of thimerosal in vaccine and they have concluded it is a perfectly safe ingredient to use in vaccines. If thimerosal is so safe, then why did its use come to a tragic end nearly two decades ago?

Starting in the early 1990s there was an increase in the number of autism diagnoses, so naturally people wanted answers. More specifically the parents of autistic children wanted answers and where do most people go to gather the quickest information. That’s right… the internet. Unfortunately, not all information on the web is well-researched or even true. That being said these parents embarked on a search for answers and the web served as a platform in which people from many different areas could converse and form advocacy groups. An article, written by PhD holder Jeffrey P. Baker, found that among the forming of these parental advocacy groups, the notion of an autism “epidemic” first took root. These organizations were able to reach those who would have normally been unreachable while also creating a sense of urgency for the growing autistic epidemic. While the advocacy groups started the autism hysterics, what linked thimerosal in the public’s mind to the autism “epidemic”?

I have a feeling the final nail in the thimerosal coffin was Andrew Wakefield’s anti-vaccine article (If you want to know more about the craziness that ensued from his biased piece of garbage article, then check out my previous blog post). Wakefield’s article was publicly published in 1998, so the timeline matches. In a nutshell his study reported that a small number of patients developed autistic regression after getting their measles-mumps-rubella (MMR) immunization. As soon as this was published people went into a panicked frenzy. The internet only heightened this anti-vaccine controversy because parents of autistic children believed Wakefield’s findings and spread his ideas like wildfire around their communities and online. Despite the failure to confirm Wakefield’s findings people linked the cause of autism to vaccines and their minds could not be changed. The MMR vaccine doesn’t even contain thimerosal, but this hysteria over vaccines causing autism was enough for people to look at all vaccines and blame it on the ingredients. It seems thimerosal was the perfect scapegoat since it contains mercury. However, as I stated above this is a different type of mercury known as ethylmercury which is safer for human use. Many studies have shown there is no connection between thimerosal and autism, but sadly it was still removed from children’s vaccines in 2001.

I’m sure above the thimerosal grave, its stone reads, “Here lies the sweetest little vaccine ingredient who wanted to do nothing but help those in need. Gone too soon, fly high little angel”. Yes, very sad that thimerosal is no longer used in children’s vaccines, but there is some good news! If you’re a fan of thimerosal’s work, then have no fear because thimerosal is still an active ingredient in some flu vaccines.

Say Yes to the Vaccine

There are so many things a bride-to-be has to consider before choosing the dress of their dreams: cost, practicality, ease of use and few consequences (like nip slips). Most of these are analogous to creating an ideal vaccine. The ideal vaccine should be inexpensive to produce, induce long-lasting protective immunity, easy to use and have few side effects. While it takes brides months, or even a few years, to pick out the perfect dress. It takes scientists somewhere between 10 to 15 years to develop a new vaccine. This is because vaccines have to go through different phases of development including research, discovery, pre-clinical testing, clinical testing, and then approval. The clinical testing can take up to a decade before approval. As it should, though. I mean I don’t know about you, but if I’m about to put a vaccine in my body I want it to be as safe as possible, so the more tests that it passes the better. I guess length of time is where the dress/vaccine analogy diverges. I mean if you are spending 10 to 15 years looking for the perfect dress, then you probably aren’t getting married. Now, without further ado, are you ready to say Yes to the Vaccine?

New vaccines are constantly being proposed, tested and approved. A recent article discusses the immunogenicity, safety and tolerability of a new measles-vectored chikungunya virus vaccine (MV-CHIK). Chikungunya is similar to measles because it is a viral infection spread by mosquitoes. The study used a double-blind, placebo-controlled, randomized method with healthy volunteers between the age of 18 and 55 years old to participate. Testing was conducted at four study sites in Austria and Germany. The primary goal of the vaccine was to achieve immunogenicity which they described as the presence of neutralizing antibodies against the chikungunya virus. Science Direct defines neutralizing antibodies as critical contributors of the protective response against viral infections.

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The MV-CHIK vaccine is a live-attenuated vaccine. According to the CDC, live-attenuated vaccines are used to fight against viruses and bacteria. These vaccines are NOT to be used if you are immunocompromised because they contain weakened versions of the living virus, so they might cause serious disease. So far MV-CHIK has showed great safety, tolerability and immunogenicity against the vector. It is also a promising candidate vaccine for preventing chikungunya fever.

Since live-attenuated vaccines are so similar to the natural infection they are helping to prevent, they are able to create a life-time protective immune response. In just 1 or 2 doses of these vaccines, you now have a long-lasting protection against the disease. I believe that since you are receiving long-lasting immunity, B cells are being generated. These B cells are able to form memory cells to help you fight off future contacts with the chikungunya virus.

Marco Polio

It’s summertime, and the weather forecast calls for a high of 85 degrees Celsius and sunshine, so where do you go? You go to the pool, of course. You hop in your car and gather a few friends, and you all venture out to find a nearby place to swim and relax. While splishing and splashing around, one of your friends suggests a game of Marco Polo. I mean, who doesn’t love a good game of Marco Polo? Well, you and your friends love the game of tag so much that you never want it to end. Good news! The game doesn’t have to end if you simply choose to not get vaccinated for polio. Now you can play a game of Marco Polio where you try to avoid contracting the poliovirus. Oh, what fun!

Photo via Naija AgroNet

Pictured to the right is a group of individuals in Nigeria who have been infected with the poliovirus. It’s heartbreaking to see what this disease is capable of doing to the body. In reality, playing Marco Polio is not something you want to do. According to the CDC, a poliovirus infection usually has flu-like symptoms such as: fever, tiredness, nausea and sore throat. However, this disease is also associated with other more serious symptoms that affect the brain and spinal cord. Polio can cause meningitis and even life-long paralysis. Luckily, contracting polio is easily preventable with immunization.

There have been great strides in recent years to eradicate polio worldwide. Polio cases originating in the United States have been eradicated since 1979, reports the CDC. That doesn’t mean polio has not been brought into this country by travelers from other countries. There are still a few countries that have not stopped the transmission of polio. One of these countries is Nigeria. A recent article describes the BMC Public Health’s attempt at targeting the last polio sanctuaries with Directly Observed Oral Polio Vaccination (DOPV) in northern Nigeria. Their strategy is to supervise the vaccination of children to ensure compliance. Since they knew parents would be hesitant, they used incentives in hopes that parents would allow their children to be vaccinated. In other words, they were lured into allowing their children to become immunized against the poliovirus. Did this bribery work to their advantage?

Photo via Islam today

It did! The article states a steady increase in population immunity was seen in all DOPV implementations. This strategy was successful in improving the uptake of polio vaccines and decreasing polio transmission in high-risk areas such as Nigeria. An oral polio vaccine (OPV) was used in Nigeria for a specific reason. Nester’s Microbiology ninth edition states the OPV is an attenuated vaccine which “consists of strains that replicate in cells that line the throat and intestinal tract.” This type of vaccine is great for third-world countries where immunization is not easily accessible because it allows for longer protection and usually only requires one or two doses. On the other hand, the inactivated polio vaccine (IPV) is more for countries that have constant access to vaccines. According to Nester’s Microbiology ninth edition, the IPV is composed of inactivated virus particles and has “the disadvantage of requiring a series of injections for maximum protection.” This means the person will likely have to make multiple trips to the doctor’s office to receive their injections. Which vaccine is used depends on environmental factors as well as financial factors. The OPV is cheaper than the IPV, but more importantly, both are perfectly safe at protecting you from the poliovirus.

Moral of the story being get vaccinated. Please, get vaccinated for polio and stick to playing Marco Polo, not Marco Polio.

TB Has G2G

Okay, it has to be said. Mycobacterium tuberculosis has got to go. There I said it. Is this an unpopular opinion or do you agree? If you don’t agree and think that M. tuberculosis is fine as it is, then allow me to try and change your mind. I think we should start at the beginning here. According to Science Direct, M. tuberculosis is a human pathogen whose origins are ancient. Apparently spinal deformities, caused by this bacterium, have been found in human remains as far back as 5000 BCE. I mean big deal, right? So what if this pathogen has been around for thousands of years. Well, this pathogen is the cause of tuberculosis (TB) which can be fatal if not properly treated. Still not convinced that TB has to go? Let’s explore some more.

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The CDC states those with TB develop a really bad cough that can last three weeks or longer. The cough might even get bad enough to where the person coughs up blood or sputum. TB is a highly contagious disease because the bacteria is spread through the air from one person to another. It’s so contagious that if you were to enter a room after someone with TB has been coughing in it, then you run the risk of inhaling all those infectious airborne particles.

TB became an epidemic in the seventeenth century when urbanization in Western Europe was on the rise. This made it easier for the disease to spread from person to person. Science Direct reveals that within 200 years of the epidemic most of the European population had been infected and about one fourth of the population had died. I think I’ve made my point as to why TB has to go. If I haven’t then you should know that TB can in fact get worse. The World Health Organization reports that M. tuberculosis can develop resistance to antimicrobial drugs used to cure TB. This is definitely not good! Multidrug-resistant tuberculosis (MDR TB) does not respond to Isoniazid and Rifampicin which are two of the main anti-TB drugs.

A recent article looked at the evaluation of MDR TB supplemental surveillance in the United States. TB supplemental surveillance relies on the report cases and data from laboratories. This information is given to local health departments and used to control and prevent TB from continuing to be a health concern. Appropriate actions can be taken from the information collected by TB supplemental surveillance in the US. The objective of the article was to provide new clinical insights into the treatment, administration, and illness associated with MDR TB treatment in the US. There isn’t a ton of MDR TB surveillance data outside of research projects, but the study conducted in this article shows a first attempt to nationally standardize and quantify clinical features of MDR TB treatment and management in the US. The final proposed form has even been accepted to be included in the national surveillance system that is going to be implemented in 2020.

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Drug resistant TB can be infuriating when it comes to TB control. MDR TB creates obstacles in overcoming the spread of TB due to its acquired drug resistance. Another article found that while there are limited options for those who are resistant to normal treatments for TB, there might be a so called “Salvage Regimen.” This regimen is a combination of both Bedaquiline and Delamanid and when assessed showed that is was efficacious and safe for use. This is promising news in the emerging antibiotic resistant world. The CDC reports that the cost of the average MDR TB patient is $134,000 while the estimated cost of a non-MDR TB patient is $17,000. Drug resistance is costly in more than one way; it was also found that drug resistant care was complex and treatment rates were high. While treatment of MDR TB is possible it does come at a high price.

The Walking Pneumonia

Walking pneumonia sounds eerily similar to The Walking Dead. Coincidence?! I think not. The Walking Dead deals with scary zombies that will kill you, so this must mean this disease is scary and will kill you too. My logic here is air tight, right? Well, not really. In reality, walking pneumonia is the least scary type of pneumonia that exists. This upper and lower respiratory tract infection is actually quite common. The Cleveland Clinic reports an estimated 2 million cases occur each year in the United States. This clinic describes the typical signs and symptoms of walking pneumonia as a sore throat, inflamed trachea and bronchi of the lungs, low-grade fever, headache and a persistent dry cough. It sounds more like a nuisance than anything.

Photo via Frontiers in Microbiology

Photo via FEMS

The tiny, bothersome bacteria pictured above are responsible for walking pneumonia. They go by the name of Mycoplasma pneumoniae. Mycoplasma pneumoniae pneumonia (MPP) usually resembles a cold. In fact, most people may not even be aware they have MPP, but instead think they have a cold or the flu. As with most diseases people who are immunocompromised are at greater risk of developing a serious response to MPP than those with a healthy immune system.

Photo via quickmeme

More often than not MPP symptoms go away on their own, but antibiotics can help speed up the healing process if introduced early enough in the illness. Medscape reports that the antibiotics of choice for MPP are usually macrolides and second-generation tetracyclines such as doxycycline. They are extremely effective at eliminating MPP infections. However, there has been increased macrolide resistance throughout the world. In a recent case report, a 39-year-old woman came into a hospital with a rare case of life-threatening MPP due to a macrolide-resistant strain. When treatment with macrolide and corticosteroid failed, she was then successfully treated with fluoroquinolone and tetracycline. While this was a rare instance, it is still important to be aware that emergence of antibiotic-resistant MPP is on the rise.

Welcome to HPV World

Chances are at some point today you crossed paths with someone who has the Human papillomavirus, or HPV. It could be the barista who always wears that yellow beanie and makes your Chai Tea Latte every morning or the desk clerk that greets you everyday on your way up to work, or it could even be you. The point is HPV is everywhere; it is the most common sexually-transmitted infection in the United States. According to the CDC, 79 million Americans are already infected, and roughly 14 million people become newly infected each year from this virus. You’re probably thinking there’s no way you could have HPV and not know about it. Unfortunately, where there’s a will, there’s a way. Those with HPV are sometimes asymptomatic, meaning they are infected but show no sign or symptoms. Even with no signs or symptoms, you are still infectious to anyone with whom you become sexually active.

While there are over 100 varieties of HPV, most of them take the form of genital warts. The Mayo Clinic describes these types of warts as either flat lesions, small cauliflower-like bumps or tiny stem-like protrusions. For women, the warts usually appear on the vulva but have been known to show up near the anus or cervix. For men, they appear on the penis, scrotum or around the anus. Though the warts seldom cause pain, they are known to be quite itchy and uncomfortable. That doesn’t sound too appealing, does it?

Fortunately, there are vaccines that can help stop these health issues from ever happening. In a recent article, it was found that the bivalent and quadrivalent HPV vaccines have exceeded expectations in preventing HPV infections which can lead to cervical cancer for some people. These vaccines contain virus-like particles that stimulate the body to produce antibodies that respond to HPV 16, 18, and two other HPV types. They are extremely effective in prevention of targeted HPV infections. In other words, all hope is not lost! Just make sure to practice safe sex, get regular checkups, and most importantly…get vaccinated. If you do start to develop the signs of HPV, understand that you are not alone. In fact, the CDC reports HPV is so common that almost every person who is sexually active will get it at some point in their life (unless they get the vaccine).

The most well-known quadrivalent HPV vaccine is Gardasil^®, while the most-used bivalent HPV vaccine is Cervarix^®. A review article from 2012 looked at the clinical trials of both Gardasil® and Cervarix® involving human participants. This article made sure all trials were large (5,500-18,500 vaccinees), blinded, randomized and controlled trials of young women (mean age 20, range 15-26). They found both of the HPV vaccines had great potential as high-value public health interventions and helped in preventing anal and genital HPV infections from occurring. This is the exact reason why I believe vaccines are one of the greatest medical innovations to ever come about. I mean it’s amazing that we possess something powerful enough to prevent us from developing or catching a certain disease. All we have to do is make a conscious effort to go get vaccinated.

Savory Salmonella

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Doesn’t that cookie dough just make your mouth water? Go ahead, pick up the spoon and dig right in. I mean what’s the worst that could happen, right? Well, the worst part happens after you’ve devoured all that raw egg. Eggs are known to contain a bacteria called Salmonella which can cause serious and sometimes fatal illness. According to the CDC, poultry carries the bacteria and can contaminate the inside of eggs before the shell has formed. The dropping of poultry can also contaminate eggs through the laying process or from the environment. This is why it’s incredibly important that you fully cook that raw cookie dough you’re about to eat.

I cannot tell you how many times I have watched my roommate grab a tub of raw cookie dough from the fridge and just start eating it like it’s ice cream. It worries me every time. Don’t get me wrong, I love the taste as well and would like nothing more to join her, but the consequences outweigh everything for me. These infections commonly take the form of Salmonella gastroenteritis. While it is the least serious form, it still comes with some not-so-tasteful signs and symptoms. The Mayo Clinic reports the syndrome of a Salmonella infection as nausea, vomiting, fever, chills, abdominal cramps and last, but not least, diarrhea. These signs and symptoms generally last two to seven days, but the diarrhea could possibly burden you for up to 10 days. Moral of the story being that a few bites of delicious cookie dough can sometimes be a few bites of savory Salmonella.

In recent news, the CDC has issued an investigation notice that a recent Salmonella Typhimurium outbreak may be linked to pet hedgehogs. Eleven people in eight states have been infected with this strain. Luckily, there have been no deaths at this time, but health officials are advising against cuddling up to these adorable little prickly creatures. Salmonella germs can be found in their droppings and can easily be spread to their bodies. As cute as they are, I still don’t get the urge to cuddle with a hedgehog but to each their own. If you are one of those people who owns a pet hedgehog, you should wash your hands regularly, clean their habitat, and avoid getting too up close and personal with them. I know…I know, it’s tempting.

The Unwoke Life of Andrew Wakefield

Today’s post will be about the ever so deceitful Andrew Wakefield and what is now known as his “MMR causes Autism” hypothesis. This post will involve some intense topics such as lies, deceit and fraud, so caution advised.

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The man of dishonor, Andrew Wakefield, is a former British doctor who is now a huge supporter of the anti-vaccination movement. His involvement with this movement began in the late 1990’s as did his rise to fame. According to the Indian Journal of Psychiatry, in 1998 Wakefield and 12 of his colleagues published findings that there was a link between the measles, mumps, and rubella vaccine (MMR vaccine) and autism. According to The Lancet, Wakefield hypothesized the MMR vaccine causes damage to the guts of children who then revert developmentally and become autistic. When news of this hit the public, widespread hysteria ensued. Parents stopped getting their children vaccinated over concern that they might develop autism. This panic would have been fine if it were not for the fact that Wakefield had just committed scientific fraud. Not only does the MMR vaccine benefit children, the CDC reports there is no link between vaccines and developing autism. With that being said, let’s delve into the experimental design carried out over 20 years ago.

The first flaw of many in Wakefield’s unethical experimental design was his sample size. He only studied a mere 12 children. That’s all! To make matters worse, this article states the children were not randomly selected but rather the parents of these children came to Wakefield specifically. A true scientist would know that the best method to use for this kind of research would be a double-blind procedure. This is where neither the participants nor the experimenters know who is in the test or control group. However, Wakefield chose not to go this route. So what was his reason?

What better reason could there be besides money? The Indian Journal of Psychiatry found Wakefield had been funded by lawyers who had been hired by parents who were currently involved in lawsuits against vaccine-producing companies. Just let that sink in for a second. He was given money (probably a lot, too) to produce biased results to benefit a select group of people with an agenda.

Since the discovery of Wakefield’s false findings, The Lancet has retracted his 1998 paper, and in 2010 Andrew Wakefield became a discredited former doctor. Unfortunately, the MMR vaccine scare that arose from Wakefield’s professional misconduct is still impacting vaccine hesitancy today. According to NCBI, measles cases in the U.S. reached a 20-year high in 2014 due to people not being vaccinated. This shows Wakefield’s paper is still being used as a driving force for the anti-vaccination movement.

The only good thing to come out of the Wakefield scandal is increased awareness for the importance of ethical responsibility. Scientists are among the most reputable sources when it comes to credible information. We as a community put our trust in the findings that scientists publish. We expect well-researched, factual, and, more importantly, TRUTHFUL results that will influence our decision-making for the better. Scientists should be aware of the impact their findings have on the public because any error or falsification can have detrimental consequences as seen in the Wakefield incident.

No Vaccine for Ignorance

*Caution: If you are a person who thinks that vaccines cause you to get sick and are easily offended, then I would recommend not reading this post.*

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Do you want to know what’s funnier than adults thinking that vaccines cause illness? Absolutely nothing. There is cold, hard evidence out there stating that vaccines help prevent disease and yet people are resistant to getting them. So why is “vaccine hesitancy” still prevalent in today’s society? A recent study conducted at Dartmouth College may have the answer to this question. The study found that past problems with vaccines cause a phenomenon known as hysteresis. This is because once people become skeptical or weary of a certain thing, in this case vaccines, it is hard to change their minds. Sadly, this is still the case even when there is overwhelming evidence that vaccines are beneficial. The past has a very powerful influence on the future.

You know that saying that goes: the more, the merrier. Well, in this instance the more is not the merrier. As more people become hesitant to vaccinations the greater the risk of spreading infectious diseases. Getting vaccinated not only protects you from disease, but those around you as well. Vaccination protects your children, your family, and even your next door neighbor. If you take matters into your own hands and decide not to get vaccinated, then you are allowing yourself to be vulnerable. According to the CDC, if vaccination rates dropped to low levels, then diseases that were previously eradicated could become common again. The reason being that most vaccine-preventable diseases are spread through person-to-person contact, so if you are not vaccinated and come into contact with an infected individual you have a high chance of contracting that disease.

Unfortunately, vaccine hesitancy is directly impacting measles. The World Health Organization reports that there has been a 30% increase in measles’ cases globally in the last year. While not all the cases can be attributed to vaccine hesitancy, most of them can be. In conclusion for today’s blog I will leave you with a video that sums up the myths that surround vaccines: Click Here!