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

x

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 

x

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

x

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