Hepatitis C Outbreak in Prisons- who's responsibility is medical care?

The prevalence of Hepatitis C infection in US prisoners is 17%. That is 17x higher than the general population prevalence, which is just around 1%. Though there is an effective and curative treatment available for Hepatitis C, access to these drugs has yet to reach incarcerated people. Of the estimated 144000 incarcerated people who are currently infected with HIV, only about 3% are receiving treatment. Advocates say this is in direct violation to constitutional law, and the Supreme Court's ruling that incarcerated people have a right to medical care. Prisons say they simply don't have the money. A single course of Hepatitis C treatment can cost up to $90,000 dollars, so its true that cost really is prohibitively high. This is yet another case in which the science has advanced far enough for cures to be available, but social policies and structures make it impossible for everyone to access these life-saving treatments. If drug development is expensive, but everyone, even the poor, marginalized, and incarcerated have a right to medical care, who is going to bear the cost of developing and providing that care? This is a huge issue, but one that is clearly viewable in the continued Hepatitis C outbreak among incarcerated Americans. 

~Lisa Manzanete

References:

- https://www.hepmag.com/article/advocates-say-ending-hepatitis-c-epidemic-must-start-prisons

- https://www.governing.com/topics/public-justice-safety/khn-state-prison-inmates-hepatitis.html

Zoonoses becoming Human Infections? Hanta outbreak in Argentina

There's an outbreak of Andes virus happening in the southern region of Patagonia in Argentina right now. Cases first began occurring in late 2018 and are still going strong. Andes virus is a species of hantavirus that is spread by rodents. This virus does not exist in the United States, but is similar, in many ways to the hantaviruses Sin Nombre and Seoul, which are now endemic to the southwestern United States. 
Hantavirus symptoms typically start off like the flu: headache, fever, chills, nausea, diarrhea and muscle aches. However, in a portion of those infected, it can progress to the very serious Hantavirus Pulmonary Syndrome (HPS), which causes the lungs to fill with fluid and is often fatal, even with treatment. This is true of all the Hantaviruses. Andes virus, however, has one particularly concerning characteristic. It can also spread human to human. All human hantaviruses are rodent born zoonoses, acquired from contact with rodents or their feces. However, an individual who contracts Andes virus in this way can infect other humans directly, through close physical contact. Many existing human pathogens began as zoonoses that became more and more effective at human transmission. The potential for this to occur with Andes virus is deeply concerning. 
For now, the CDC recommends travelers to the region avoid contacts with sick individuals, rodents or anything that could be contaminated with rodent feces, and that travelers report any flu like symptoms to their doctor immediately. 

~Lisa Manzanete

References
- https://www.cdc.gov/hantavirus/resources/andes-virus.html
- https://wwwnc.cdc.gov/travel/notices/watch/andes-virus-hantavirus-argentina

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Getting infected with the flu...for science? (Promising new flu vaccine)

A novel influenza vaccine being developed by FluGen, a subgroup of the Swiss biotech firm SGS, is showing remarkable promise in a Phase 2 clinical trial in humans. The vaccine aims to protect against Influenza A H3N2. This strain is important because its more severe than other strains and especially because it has an especially high mutation rate. This makes it one of the hardest influenza strains to consistently develop effective vaccines against. Last year’s H3N2 vaccine was only about 6% effective. Its important to note that last year’s flu vaccine overall was NOT only 6% effective. Since the vaccine is multi-valent, the vaccine can be effective overall even if it fails with one of the strains it was meant to protect against. The vaccine in question is interesting because though it is live attenuated, it is attenuated in a novel way: it has been molecularly engineered such that the virus can only complete one replication cycle after it has been administered (as a nasal spray). The craziest thing about this news to me though, is not the ingenuity of the researchers in their approach, but the design of the trial with which they’ve tested it. In a placebo controlled study with 99 participants. Half the participants received the vaccine, and the other half received a placebo. Then, all the participants were (willingly!) infected with H3N2 influenza virus. Essentially, they consented to a 50% chance of being given the flu with no prophylaxis. So far, it appears participants who received the vaccine did in fact have lower viral loads once infected. There’s still a lot to be done before this vaccine is even ready to be considered for market, but its an exciting step in the development of ever more efficacious flu vaccinations. 

~Lisa Manzanete

Reference:

• https://www.healio.com/infectious-disease/influenza/news/online/%7B9bbd2f2d-6557-4c86-a7bd-ed13bc284285%7D/novel-flu-vaccine-shows-efficacy-against-mismatched-h3n2-virus

• https://www.sgs.com/en/news/2019/03/successful-phase-2-clinical-trial-results-for-novel-influenza-vaccine 

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Pox Parties: Foolish Festivities

An NYTimes article came out today with the title “Remember Chickenpox Parties?” I certainly had no idea what those were, so naturally, I had to investigate. It turns out that prior to the invention of the Varicella Zoster Virus vaccine in 1995, chickenpox parties were fairly common practice. Because of the widespread and not incorrect belief that contracting chickenpox during childhood was safer than contracting it during adulthood, parents would intentionally expose their kids to the illness. If one kid in the neighborhood got sick, other friends and family would bring their kids over so the virus would be spread to all the “pox party” attendees. Though it sounds crazy, prior to the existence of the vaccine this was a bold strategy, sure, but not a completely terrible one. Catching chickenpox once means you'll never catch it again, and it really is worse in adulthood. After the invention of the vaccine, however, which carries a much lower risk of complications, the popularity of these parties died down in the wake of a better option. 

Chickenpox parties are back in the news now because, unfortunately, they're coming back into vogue, as part of the anti-vaxxer movement. There are some high profile people participating: the governor of Kentucky said in an interview on Tuesday that all 9 (nine!) of his children attended chickenpox parties rather than receive the vaccine. Chickenpox parties may not be immediately lethal, but in a world with an effective and safe vaccine, chickenpox parties are bad for everyone. Kids who get chickenpox and recover will be fine, and immune, true, but they will be shedding virus and can infect vulnerable individuals. Kids who receive the vaccine will be immune without ever getting sick, and they will shed the virus at a much lower rate and so are less likely to spread the illness. Plus, some may develop complications that can lead to hospitalizations or even death. Most bizarre of all, the governor’s wife and the mother of those kids is a registered nurse. Why!

Vaccinate kids y’all. Its the safest choice for the child, the family, and the community.

~Lisa Manzanete

References: 

• https://www.nytimes.com/2019/03/21/us/kentucky-governor-chickenpox.html

• https://www.ncbi.nlm.nih.gov/pubmed/29070705

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US Resumes Controversial Research on Modifying Bird Blu

After 4 years of stasis, the US has approved experiments proposed by two labs related to modifying bird flu viruses to make them more infectious. The two labs given the green light were Yoshihiro Kawaoka's in UW Madison and the University of Tokyo, and Ron Fouchier's at Erasmus University Medical. In 2011, the two researchers separately announced that they had modified H5N1 avian flu to allow it to spread among ferrets. The research immediately raised concerns that the deadly flu, which previously could not spread to humans, could now bridge the mammalian gap. In 2014, similar gain of function research on SARS, MERS and influenza were placed on hold. Now, the HHS has reapproved the grants of both labs.

Part of the controversy arises in the method of approval - the HHS refused to publicize the news, and many scientists only learned of the approval through an insider at the department leaking information. Critics call for the HHS to explain why it reapproved the research after years of keeping it on ice. Other researchers expressed irritation that the decision was made privately after heavy consultation of the field. The HHS has requested more stringent reporting requirements - if Kawaoka is to discover a strand with high infectivity and is transmissible respiratorily, he must report it to officials at the NIAID and his university.

For more information, see : https://www.sciencemag.org/news/2019/02/exclusive-controversial-experiments-make-bird-flu-more-risky-poised-resume

-Ed

Mosquitoborne Illness and Flood Linkage

Natural disasters often carry associated disease related risks. After several floods, the New South Wales Arbovirus Surveillance and Mosquito Monitoring Program was established to take note of the association between flooding and the prevalence of mosquitoborne disease. For example, a similar task force in New Orleans post- Hurricane Katrina noted a massive increase in cases of West Nile. In Australia, the incidence of Murray Valley Encephalitis Virus increased dramatically post flooding in 1970, and there is an anticipated increase in MVEV during this flooding as well. An increase in disease presence isn't always the case, however, because flooding also kills some of the reservoirs (see previous blog post) for the disease, so it is often case dependent. With the increase in extreme weather associated with global warming this will become a much more relevant issue. 

https://theconversation.com/after-the-floods-come-the-mosquitoes-but-the-disease-risk-is-more-difficult-to-predict-111173

Anja Zehfuss

 

Murray Valley Encephalitis

Murray Valley Encephalitis is an arboviral disease that is endemic to Western Australia. MVE is a flavivirus that is closely related to a more common encephalitic virus in Asia, Japanese Encephalitis Virus. Waterfowl and chickens provide a common reservoir for MVE in Australia, and then the disease is carried from these birds to humans via mosquitoes. Most cases are asymptomatic, but the disease is severe when it causes symptoms- about 25% of cases result in death. Right now the rarity of the disease means that it hasn't been a huge cause of death in Australia, but other encephalitic diseases have been terrors to their regions. If MVE was carried by birds throughout the entirety of Australia, instead of just occasional waterfowl in Western Australia, then this disease could become a major killer. Thankfully the Australian health authorities are tracking the spread of the virus to make sure it continues to be contained.

http://theconversation.com/explainer-what-is-murray-valley-encephalitis-virus-112212

Anja

Herpes Coming Out of Dormancy?? Less Gnarly than Anticipated

Several days ago there was a study published in Frontiers in Microbiology  about herpes virus reactivation in astronauts in space. About 50% of astronauts that were exposed to spaceflight, as well as over 60% of astronauts aboard the International Space Station had reactivation of herpes viruses ranging from Varicella Zoster to Epstein Barr Virus to the less malignant Herpes Simplex 1. While this is a very shocking headline that could freak out the casual observer (viruses re-emerging like the Kraken from the depths of the human immune system??), this is actually less bad than anticipated. Viruses like EBV or HSV are characterized by their ability to resurface during times of stress. Shockingly enough, intense and risk-prone spaceflight is an example of a high stress period. While the shedding of the virus caused by exposure to space and associated cortisol levels isn't great for the astronaut's overall health, it probably isn't terrible either as the astronauts have most likely been previously exposed to these common diseases. All in all, I would recommend strengthening the immune system as much as possible pre-flight and (of course!) a strict regimen of handwashing.

https://www.frontiersin.org/articles/10.3389/fmicb.2019.00016/full

Anja Zehfuss

We Really Gotta Stop Keeping Smallpox in Random Boxes in the CDC: Reasons Why

We've discussed a lot in class why we should just eliminate our last stashes of eradicated viruses. For example, we have smallpox samples in Russia and in Atlanta. They also found a couple of vials of still-live smallpox in a random locked fridge in the National Institute of Health. Thankfully no one became infected, but it was a distinct possibility. For diseases as dangerous as smallpox, completely wiping them off of the face of the Earth is the safest option. I understand the nuclear equivalent argument (if Russia has them, we should too), but storing the virus in the US in any capacity isn't helping us at all it is just increasing the possibility for human error the longer it is present here. And it isn't just smallpox. According to the FDA, hundreds of unintended exposures to biological (and disease-causing) factors occur a year. Not all of these involve smallpox or other infectious agents that can eliminate millions off of the face of the Earth, but you only need one mistake with a dangerous virus to release it into the US. Thankfully, the Center of Disease control and the NIH (among others) do a good job of preventing the spread of these diseases after the mistake has been made (see the smallpox exposure in Britain in the 1980s when 1 woman died and 300 were preventatively hospitalized) but it is a matter of time before we make a mistake we can't contain.

And on that happy note, here is my article!
https://www.vox.com/future-perfect/2019/3/20/18260669/deadly-pathogens-escape-lab-smallpox-bird-flu
Anja Zehfuss

Multipartite Plant Viruses

There is finally firm proof that viruses can split into multiple parts that never actually meet and just reproduce independently. To the casual observer, this makes no sense. It just so happens that it also makes no sense to high level virologists, who studied the phenomenon for 6 years after confirming its' existence just to confirm that they were seeing what they thought they were. Fava Bean Necrotic Stunt Virus, or FBNSV, is a virus thats' genome is split in 8 parts. Each of these eight parts is contained in a different capsule. Originally it was theorized that each of these eight capsules were all simultaneously infecting the same cell and reproducing from there, but this was pretty much mathematically impossible. After they found that, the virologists realized that there had to be a way for the capsules to reproduce independently and combine (even though some bits encoded the capsule, for example, while others encoded the DNA polymerase). 6 years of work later they found that for plant proteins in particular there is a network that connects cells and allows proteins to combine. This system allows multipartite plant viruses to recombine and function, but prevents the same technique from working in humans. 

https://www.theatlantic.com/science/archive/2019/03/the-revolutionary-discovery-of-a-distributed-virus/584884/

Anja Zehfuss

3/20

U.S. Funds $10 million towards Marburg vaccine

Marburg, a hemorrhagic fever virus, has long been considered a potential bioweapon, as deemed so by the U.S. Department of Homeland Security. Since it was discovered in the 1960s, it’s re-emerged several times in the form of outbreaks, in one particularly deadly outbreak, it achieved about an eighty percent mortality rate. A biotech firm in Massachusetts received a Biomedical Advanced Research and Development authority (BARDA) award in the form of a two-year, ten million dollar contract to work on developing a vaccine. Should they be successful, they will be eligible to receive up to $72 million dollars to advance through stage II clinical trials.However, the question still remains as to why did the U.S. government thought it so worthy to invest in developing a vaccine all of a sudden, especially since it was long ago identified as a potential bioweapon, and it’s primary  infected demographic is outside of the U.S.  Read more at:   https://www.telegraph.co.uk/news/2019/03/19/bioterror-fears-marburg-ebolas-deadlier-cousin-us-begins-10m/

-Brittany Stinson

Mononucleosis is a form of EBV which is human herpes virus. Infectious mononucleosis infects 1% to 5% of college students and six months later 10% of those turn out to have chronic fatigue syndrome. Chronic fatigue syndrome makes it super difficult to function generally by making cognition and motion really taxing on the body. Recently, researchers have developed a new scale so that they are able to detect whether people are at risk of having chronic fatigue syndrome before a six month follow up assessment. They found that those who scored high on their test were significantly more likely to later be diagnosed with chronic fatigue symptoms or at least show multiple symptoms of it after six months. This suggests that their new test could be a measure for diagnosing cases that are likely to present with chronic fatigue syndrome later which could help patients to be aware of their condition earlier.

For more information visit: https://www.sciencedaily.com/releases/2019/03/190320120539.htm

-India Robinson

Medusavirus and the origin of species

I found this sick Atlantic article about virus that turns stuff to stone. This virus is called medusavirus. It is interesting partially because of its size- it has acquired advanced mechanisms from bacteria and more evolved cells. For example, the medusavirus has stolen 5 histones. Because the virus predominantly infects amoebas (and turns them to "stone" aka causes them to defensively shrivel and harden), it is theorized that these histones originated as amoeba histones. Examining the medusavirus genome proves this to be at least partially true, because there have been over 50 incidences of genetic crossover between the amoebas and the virus. The Atlantic speculates, however, that if some of the histones originated in the virus itself this virus (among other large viruses like it) could be proof of the origin of species. If these viruses have self-containing and high level histones and aspects of replication then they could have been part of the building blocks of the first species.

https://www.theatlantic.com/science/archive/2019/03/giant-medusavirus-hosts-turn-to-stone/585289/

Anja Zehfuss
3/20

DNA viruses welcome a new member

Medusavirus, a new large DNA virus was isolated from a hot spring in Japan by Masaharu Takemura, a virologist at the Tokyo University of Science. The researchers at Tokyo University proposed that it be a part of it’s own family, medusa virus. It’s aptly named after Medusa, because when Takemura grew microbes from the hot spring mud in his lab, notice that amoebas died in the presence of this virus, having bursted open in as  a result. However other cells would harden and shrivel, much how like Medusa turns her male victims into stone.  s for electron morphology, it is icosahedral and covered in spikes (remind you of adenovirus?). When sequencing its genome, they found some molecular peculiarities, it has genes encoding for all five types of histones that are present in complex cells. There are a couple of theories as to how it acquired these histones… to find out read on here:  https://www.theatlantic.com/science/archive/2019/03/giant-medusavirus-hosts-turn-to-stone/585289/  -Brittany Stinson

Nonhuman Primates as Zika Reservoirs in the Americas

Many viruses are known to have jumped to humans from other animal species (including influenza and HIV), but the reverse is also possible - human viruses can infect other animal species, creating a reservoir that maintains the threat of human epidemics long after every human case has been treated. Researchers at Washington University in St. Louis are studying nonhuman primates in South America to see if they have become a potential reservoir for Zika. In order to do so, they developed a noninvasive way to test nonhuman primates for Zika using fecal samples and published their work in PLOS ONE.

While Zika can be found in a variety of bodily fluids, including semen, saliva, blood, and urine, feces presents the safest and easiest way for researchers to collect the samples at scale. However, feces is loaded with contaminants and RNA viruses are often not as resistant to the environment, making it a difficult thing to test for. The method from WashU was validated against a gold-standard qRT-PCR based assay and has now been used to evaluate samples from nearly 50 animals in Ecuador, Colombia, and Brazil.

Read more at: https://www.sciencedaily.com/releases/2019/03/190319182238.htm

- Arjun Kumar

HBV used to track migration of ancient humans

Researchers have been able to use HBV genome sequencing to track the movement of ancient human populations into Australia. The discovery was happenstance to research being done to characterize HBV strains in indigenous Australian populations. Chronic HBV, one of the major causes of hepatocellular carcinoma, is endemic in Australian Aboriginal and Torres Strait Islander people. Researchers have used the human genome to trace ancient human migration, but this case is of particular interest because it is not the direct human genome that is being traced, but one of the pathogens that has hitched a ride with these groups of people and evolved with them over time. The study was published in the Journal of Molecular Biology and Evolution and reportedly used gene sequencing of HBV DNA, archaeological fossils, and human genomes to develop the study. What the researches found was that the mother strain to the modern HBV/C4 virus entered Australia thousands of years ago, and separated into two groups which are geographically distributed in a strikingly similar manner to the two main Aboriginal Australian groups today. While this is all very fun for virus hunters, the biggest benefit it seems to have brought to the Aboriginal Australian populations is a heightened awareness of HBV in their communities. Professor Josh Davis from the University of Melbourne says that throughout the duration of their study, "community members have asked to find out more about hepatitis B and how they can be tested and treated". The modern day treatments for HBV are mediocre, but with a heightened awareness, hopefully people will begin vaccinating their children to prevent the spread of HBV to younger generations.

Renata Starbird
https://phys.org/news/2019-03-hepatitis-virus-ancient-human-population.html

Tiny but mighty particle fights against the flu

The specificity of our immune system is often a blessing; it using identifies minuscule, particular features of a pathogen to differentiate it from a host of possible disease causing specimens, and then tailor its response accordingly. However, certain viruses, including influenza, are able to turn this system on its head and engineer evolutionary changes to the specific regions of the virus that the immune system targets. This often explains why a flu vaccine will leave us immune to some but not all strains of the virus.
As a result, scientists are exploring the efficacy of perhaps not being so specific, but instead focusing on general features shared by influenza viruses, such as hemagglutinin, the H protein of the HA complex. HA is the surface protein responsible for allowing viruses to inject their genetic material into vulnerable host cells. This process can be blocked by broadly neutralizing antibodies, which defend against one of two types of HA classes. While these antibodies alone could serve as a therapy against flu infection, antibodies as a whole are often difficult to administer. They must be refrigerated before use, injected because they cannot endure the digestive tract and still run the risk of being rejected by the immune system.
To counter this problem but still use the generality exemplified by broadly neutralizing antibodies, researchers at Johnson and Johnson searched for a small molecule that could essentially out bind the antibody that would typically attach to the HA. After multiple rounds of screening and making adjustment to the molecules, scientists tested a modified molecule in mice models injected with the flu and the results were promising-the mice survived despite receiving doses of the flu that should have been lethal. The same molecule was trailed in human bronchial cells. However, far more research and consideration is needed before this small molecule therapy can materialize as a treatment and/or prevention of flu infection in humans.

-Riasoya Jodah
Source: Timmer J. A small-molecule drug can block a broad range of flu viruses in mice. Ars Technica. https://arstechnica.com/science/2019/03/a-small-molecule-drug-can-block-a-broad-range-of-flu-viruses-in-mice/. Published March 11, 2019. Accessed March 18, 2019.

Herpes...In Space

New tests show that dormant herpes viruses reactivate in over half of the astronauts aboard Space Shuttle and the International Space Station missions. NASA has released a warning after finding out it was reactivating among the crew. Their real concern is not so much with the astronauts, because only a small proportion develop symptoms, however this could have implications for long missions. The stressors of microgravity, cosmic radiation and extreme G forces puts stress on the body that can impair the immune system. This can be compounded by the psychological tolls of confinement and social separation. Researchers found that the longer the mission, the more likely the viruses were to reactivate.

-Brittany Stinson

Read more here:

https://news.sky.com/story/nasa-issues-space-herpes-warning-as-virus-reactivates-in-astronauts-11669335

Researchers use Gene Insertion to Restore the Vision of Blind Mice

Researchers at the University of California, Berkeley have used an adeno-associated virus (AAV) to restore vision to the eyes of blind mice. The treatment uses a genetically engineered AAV to introduce light sensitivity to ganglion cells. Macular degeneration leads to the destruction of rods and cones, which are the retina's photoreceptor cells, but it leaves the bipolar and retinal ganglion cells untouched. The AAV introduces a gene for light-sensitivity from green-sensitive opsin into the ganglion cells. The treated mice develop vision over the course of a few months and seem to behave just as unimpaired mice, although the exact nature of the vision provided remains to be seen. Researchers initially attempted to use the red-sensitive rhodopsin, but it was too slow for image and object recognition. Both opsins connect to the ganglion's signalling system and provide the brain with signals resembling vision. The treated mice could differentiate parallel and horizontal lines, moving and stationary lines and even dim iPad images.

For more, see:https://www.sciencedaily.com/releases/2019/03/190315095808.htm

-Ed

Patient May Be Second Person to Be Cured of HIV

A man with HIV from London received a stem-cell transplant from a donor who was genetically resistant to HIV. Extensive testing now shows he has no detectable amounts of HIV. He has been off antiretroviral drugs for around 20 months. This finding advances the search for a cure to HIV. Ravindra Gupta, who lead the study, said he and the research team said that the individual is in remission and that it is too early to say he has been cured.

The man could become the second patient cured of HIV if he continues to remain free of the virus. However, the approach can't be applied to the millions of other people living with HIV due to risk and cost. Both men cured of HIV had diseases that warranted stem-cell transplants: the first person cured Timothy Brown had leukemia and needed a transplant; the "London patient" had Hodgkin lymphoma. They both received transplants from donors who had two copies of the gene mutation CCR5, which is used by HIV strains to gain entry to the immune-system cells.


Source: https://www.wsj.com/articles/london-man-may-be-cured-of-hiv-after-stem-cell-transplant-researchers-say-11551746867

-- Caroline Aung