Cancer

No misleading titles or introduction this time, folks. Cancer doesn't require a fanciful introduction, or a surprising twist to make it scary. Cancer is one of the most scary words known to the English language, especially when spoken by a doctor. In literary terms, something is termed as 'cancerous' if it spreads to and withers or destroys everything it touches. Most of us know somebody who has either been affected by or killed by it, and nobody doubts its ability to kill or harm. Just so we're talking real numbers though, the CDC vital statistics estimates that a little over 574,000 people died of cancer in the United States in 2010. [1]

So what is a cancer, exactly? To put it in layman's terms, cancer is a cell that, through mutations accumulated by any number of ways, has forgotten how to die, and often grows unregulated. When deprived of growth medium, or become damaged, most cells will commit suicide through a process known as apoptosis. Cancer cells, however, will survive inappropriately. Some cell lines even become 'immortal' cell lines, such as the Henrietta Lacks or 'HeLa' cervical cancer cells that are still in use today, over fifty years after the donor died. 

There's a few reasons cancers are hard to treat, but one of the biggest problems is that when the cell turns cancerous, it continues to express the right Major Histocompatability Complex (MHC) molecules- the ones that identify you as you to your immune system- on the cell surface. Even though the cancer is growing and spreading rapidly, your immune system won't attack it because it sees the cancer as you. The good news is that, because humans have a wide MHC variability, it's very difficult to transmit or transplant a cancer from person to person. What would happen, though, if we had very low MHC variability? 

Devil Facial Tumor Disease (DFTD) is a transmissible cancer among Tasmanian Devils. The animals bite each other on the face, spreading cancer from animal to animal through the bites. Initially thought to have been the result of a tumorogenic virus, investigators have determined that it's actually the cancer cells being transmitted. The cancer is both disfiguring and lethal to the Tasmanian devils. 

Another big name in this field is canine transmissible venereal tumor, or CTVT.[3] CTVT is a transmissible cancer spread among dogs by sexual contact. It's not typically fatal, but recent genetic studies estimate the tumor is 11,000 years old, having persisted by jumping from dog to dog. If you believe Wikipedia, there's a third transmissible cancer spread among rodents by Mosquitos. 

Humans aren't at a very high risk for transmissible tumors because we have widely variable MHCs, but that doesn't mean it's impossible. If, for example, a tumor developed with a widely permissive MHC. What we do have are retroviruses that cause cancer by inserting their genomes into ours- such as Human Pappilomavirus. It's not that the virus' goal is to induce a tumor, so much as gene promotor or enhancer sites get accidentally copied and inserted into the host genome again. 

What makes cancer scary is that it's not some virus hijacking your protein synthesis machinery, not a bacteria or a parasite feeding on you, it's you. Sometimes, though, maybe it's someone else. 

[3]http://m.petmd.com/dog/conditions/cancer/c_dg_transmissible_venereal_tumor

[2]http://www.dpiw.tas.gov.au/inter.nsf/WebPages/LBUN-5QF86G?open

[1]http://www.cdc.gov/nchs/fastats/deaths.htm

Vaccines

Vaccines were already scary to the layperson- some stranger comes in, sticks your kid full of needles and science that does lord-knows-what by way of lord-knows-how, with little more than a verbal assurance that it'll keep them healthy. Reports abound of vaccines containing mercury, aluminum, and fermaldehyde of all things. Then, along came the Wakefield studies to ramp the scary up to whole new heights. In 1998, Dr. Andrew Wakefield of England published two studies that drew a correlation between the Measles-Mumps-Rubella (MMR) vaccine and autism. This study was promptly followed by several other studies that attempted to confirm the Wakefield papers' findings. In the meantime, the word began to spread that MMR was bad for kids. The cause got picked up by alternative medicine groups and Hollywood figures like Jenny McCarthy- who has a personal stake with an autistic child- and Jim Carrey. 

The only problem is that there's no real evidence that the MMR vaccine, or any vaccine or vaccine component for that matter, causes autism.[6][3] At least four different studies by different labs and authors were launched to review the possibility that the MMR could be causing autism, and all concluded that the vaccine did not elevate the risk of developing autism in children.[1] The paper was fully redacted by the lancet in 2010, the same year that Wakefield's license to practice medicine was pulled for performing blatantly unnecessary procedures on the children in his studies, such as lumbar punctures and colon studies. Wakefield is also believed to have been paid to preform his study against the MMR by a law firm seeking to sue the vaccine manufacturers. Of course, this is all distraction- it doesn't matter much about Wakefield himself. We're here to talk about science and scary stuff. 

On the matter of Mercury (thimerisol) in vaccines, not all Mercury is made equal. What people talk about when they say 'mercury' is an inorganic ethyl mercury salt, which is distinguished from the famous disease-causing organic methyl mercury salts you've been exposed to when you eat fish. It used to be in vaccines to prevent the growth of hazardous microbials like bacterial or fungal agents. The only childhood vaccine that still uses Thimerisol today is the inactivated influenza vaccine, since it's typically provided as a multi-dose vial. Thinerisol was voluntarily removed from most childhood vaccines in the late 90's at the request of the FDA- though it's still utilized as a preservative in a wide range of other pharmaceuticals. Even if it was still in vaccines, Thimerisol requires substantially higher doses than methyl mercury to begin causing disease- somewhere in the range of 2-3 milligrams, where vaccine thimerisol doses sit about 1000 times below that dosage. In fact, even though Thimerisol has been shown to be readily cleared from infant's bodies in their feces, the dose children receive does not exceed the FDA 'safe' level for Methyl mercury exposure. Numerous studies have also been done that establish the safety of thimerisol doses in vaccines, including addressing the charges about autism. [7 for all of that] 

As for Aluminum, it's one of the most abundent elements in the earth's crust, it's a common additive in almost anything you buy, and it's an ingredient in vaccines. Now, since the 70's, multiple studies have implicated aluminum in neurological diseases, all of which were later debunked. Aluminum is specifically added to the vaccine as an adjuvant- something used to stimulate an immune response and ensure that the immune system picks up on the target antigens in the vaccine. Aluminum has been tested for its safety in vaccines and has been proven safe, but maybe you don't believe me. Maybe you'd be interested to learn that children only receive about 4 milligrams (.004 grams) of aluminum from vaccines in a six month period, while they receive ten milligrams from breast milk, forty from formula, and 120 (thirty times as much!) from soy based formula in the same period of time. Even if aluminum did cause autism, which it doesn't, cutting out vaccines isn't the answer. For more information, look at the source I've cited for this paragraph. [8]

So where's the scary? Well, I'm getting to that, stay tuned. One of the biggest side-effects of the anti-vaccine movement is the rise in deaths from vaccine preventable diseases- diseases like measles, which was eradicated from the US in 2000 and re-established in 2004 due to poor vaccine compliance. These are diseases that have no business killing anybody. That's right, measles kills. A little under 40% of the kids sickened have to get hospitalized, and about 1 in 1000 will develop encephalitis- a swelling of the brain that causes permanent disability or death. Rubella, another disease prevented by MMR, does not cause disability quite so obviously. Instead, if a pregnant woman becomes infected with Rubella during her first trimester, the child can develop what's known as Congenital Rubella Syndrome, which causes deafness, cataracts and retinopathies (eye disease), developmental delay, permanent intellectual disability, seizures, serious heart problems, abnormal muscle tone, and several other permanent problems. There is presently no specific treatment for congenital Rubella syndrome, and Rubella was never eradicated from the United States. [9]There'a still more, though- in the United States, we've had kids dieing from Pertussis (which there are mutant strains now that can circulate in vaccinated populations thanks in part to poor vaccine compliance), dieing from HIb pneumonia, dieing from influenza, all of which are preventable by vaccines. We're on the brink of eradicating polio from the face of the planet, making it the second ever virus that we've eradicated, but fear over vaccines is opening the possibility of polio re-establishing itself in the US. There is no excuse for exposing your kids to a 1 in 100 chance of permanent paralysis. 

Not scared yet? Wait, it gets better. In some small portion of the population, some vaccines will not provide lasting immunity- we don't yet know why, as far as I am informed. We've previously been able to protect these people through a phenomenon called herd immunity, where if the vaccinated population was high enough, a disease would be unable to establish itself and spread through a population. Now that vaccine compliance has dropped, herd immunity is breaking down, and people who were protected are now at risk again. That's why vaccination isn't a personal health choice- it's a public health matter. Your decisions with vaccines can affect your neighbors, your friends, and your family. This isn't about 'maybe, in some kids, they cause autism', this is about real kids losing their lives to diseases that we've been able to prevent for years, and sometimes, it's because a stranger made the wrong decision. [4]

Before we finish, I'd like to take a moment to discuss Autism- what is it, what causes it? Autism is a neurocognitive disorder that, as current scientific evidence is indicating, you are born with due to genetic and/or pre-natal environment factors. There's a lot of good people doing a lot of hard work to figure this out. We're still learning how to define and diagnose it, and this increasing awareness and broadening diagnosis criteria has caused the sharp increase in autism diagnoses- so it's not a true epidemic. MMR specifically gets a lot of blame because of timing- its administration should happen around the one year mark of life, which is typically close to when the initial diagnosis of autism is made. The anecdotes are powerful, but that's all they are, and anecdotes aren't evidence. It's a correlating event, like saying that I was born in Oklahoma with brown hair, many Oklahomans have brown hair, therefor Oklahoma causes brown hair. Correlation, however, is not causation. Correlation, I think, is what upset parents have left to ponder on with their child's diagnosis, when science doesn't have all the answers yet. Really, it's the not knowing that's scary. 

The autism science foundation has a good resource at source [2], and you can donate to their science fund or even volunteer for studies if you have autistic children. As always, you can make a difference by doing your homework and getting educated on this matter. Share your knowledge, get vaccinated, and encourage others to do the same. 

Feel free to leave questions, comments, concerns , and/or suggestions on the blog or on my google plus account. 

[9]http://www.nlm.nih.gov/medlineplus/ency/article/001658.htm

[8]http://www.chop.edu/export/download/pdfs/articles/vaccine-education-center/aluminum.pdf

[7]http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228

[6]http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-mmr-bw-office.pdf

[5]http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-thimerosal-bw-office.pdf

[4]http://www.cdc.gov/vaccines/vpd-vac/unprotected-stories.hhttp://www.autismsciencefoundation.org/get-involved/donate

[3]http://www.autismsciencefoundation.org/autismandvaccines.html

[2]http://www.autismsciencefoundation.org/quick-facts-about-autism

[1]http://www2.aap.org/immunization/families/autismwakefield.html

There isn't much in this world to truly fear

Buuuuut I think this one qualifies. Hemorrhagic streptococcal pneumonia was observed in three patients who came in complaining of a cough. 12 hours and several rounds of strong antibiotics later, the patients were dead. Autopsies showed lungs that should outwardly appear pinkish that were dark red with hemorrhage. Here's the scary part: the streptococci were susceptible to the antibiotics that were used. 

Sleep tight, kiddies. 

http://wwwnc.cdc.gov/eid/article/20/1/13-0233_article.htm

Evolution

Wow, what a scary picture.

Credit to Wikipedia

Shaking in your boots at this pink slime? You ought to be, this isn't the Ghostbusters' pink slime, this is Klebsiella Pneumoniae. Why is Klebsiella scary enough to put on then horror blog? The story all starts with Alexander Fleming, the Scottish biologist who officially discovered penicillin in 1928. Before the discovery of penicillin, people died of bacterial infections all the time- tuberculosis, pneumonia, urinary tract infections, infected pimples or sores, sore throats, food poisoning, small cuts to surgeries. The very first patient to receive purified penicillin succumbed to his infection, because what was then the world's supply of purified penicillin was not enough to rid him of the infection he got from a rosebush scratch. When Alexander Fleming received his nobel prize for the discovery of antibiotics, he made a speech in which he warned that resistance would eventually occur. I hate to ring the 'we didn't listen' bell, but fast forward seventy years to the 90's, and we were partying pretty hard with antibiotics- not to imply that we still aren't.

Antibiotics didn't get their real boom until the second world war, around which time we figured out how to scale up and mass produce penicillin. After that, the availability of antibiotics skyrocketed, prices dropped, and we started handing them out like candy. Doctors gave pushy patients with viral respiratory infections antibiotics, when a placebo would have done the patient just as much good; We gave antibiotics out freely as preventative measures; The livestock industry is overflowing with inappropriate use of antibiotics to encourage growth, enough that they're suspected to use more antibiotics on the whole than the healthcare industry. And then, there was MRSA.

MRSA stands for Methicillin Resistant Staphylococcus Aureus. You're probably familiar with it, as the media's had a field day trying to scare the pants off of everyone with ramblings about this 'new superbug', never mind that it's been around since the 1962 (just two years after the introduction of Methicillin). S. Aureus has been blow-for-blow with us since the introduction of antibiotics, with Penicillin resistant strains showing up three years before we began mass-producing Penicillin in 1943- all the way to Vancomycin (1972) resistant strains in 2002. [2]The mechanisms of resistance vary from excreting enzymes that actually destroy antimicrobial compounds (Penicillinase), to alteration of surface proteins and development of specialized outer membranes that block antibiotic contact, to developing molecular pumps that selectively remove uptaken antimicrobials. These mechanisms are often seen in other antimicrobial resistant microbes[3]. How did these microbes develop resistance?

We did it to them- we put them under what's called selective pressure, and caused evolution. When you take an antibiotic, you don't ever quite manage to wipe out all the bacteria- especially if you don't take them like you're supposed to and don't finish the prescription out. The weaker bacteria are culled off, leaving the more resistant bacteria to reproduce and repopulate. After a few passages like that, you eventually end up colonized with something that's a lot tougher than your starting product. That then gets passed along from patient to patient, to healthcare worker, to family, and out to the community. What's more is that bacteria are actually capable of sharing genes among one another, so resistance can be conferred both intra- and inter-species of bacteria. It's not hard to imagine that, on its own, S. Aureus may not have developed some of its present resistance mechanisms, but perhaps coming in contact with a few other naturally occurring bacteria in your body that had also survived, it may have borrowed some resistance genes. Think you don't have a lot of natural bacteria? In fact, at any given time, you have ten times as many bacteria in and on you than you have cells in your body.

This all ties back to K. Pneumoniae, which, with Carbapenem resistance, had a small epidemic in 2011 at the US National Institutes of Health. In the end, 18 people became infected, and 11 people died from pneumonia. The CDC currently ranks this pathogen as an 'urgent' threat to public health, stating that "these bacteria are immediate public health threats that require urgent and aggressive action". There are three other bacteria in this category, and Klebsiella does not have the highest body count. Drug resistant K. Pneumoniae comes in at a modest 9,000 infections and 600 deaths, with the kicker that there are Carbapenem Resistant Enterobacteriaceae with resistance to all presently available antibiotics. The worst offender is Clostridium Difficile at 14,000 deaths and over $1,000,000,000 in medical expenditures.[2] In addition to all this, we have Tuberculosis that is resistant to every antibiotic we can throw at it. Today, in the United States, we are watching patients die from infections we could treat just five years ago.

It gets better, because AstraZenica, Pfizer, and other drug companies have either substantially reduced their research into new antibiotics, or have closed their antimicrobial research divisions altogether. The reasons are mainly a question of cost-benefit, given that the market forces typically value an antibiotic in the tens to low hundreds of dollars. With all the low and even medium-hanging fruits picked, a lot of drug companies feel that the reward isn't worth the effort, and they're probably right. We've seen resistance to every drug presently available, and even to novel drugs we've never used before. Resistance is developing faster and faster to fewer and fewer drugs, and bacteria are starting to gain broadly neutralizing defenses against antimicrobials, possibly rendering future drugs completely worthless.

 

To put things bluntly, the age of antibiotics is over. And the CDC agrees with me.

 

Fight the Fear

 

All hope is not yet lost, stay your hand a while longer, preppers! Do I come bearing a miraculous herbal remedy, or a secret celebrity diet? No, just good science! There is hope in fighting microbes with microbes. The Russians and east Europeans have been working with something known as phage therapy in the realm of antimicrobials since the early 1900s. The idea is simple- you use several lytic viruses that are tuned to infect bacteria (henceforth, bacteriophages), and use it to wipe out the target pathogen. It's a lot more specific than antibiotics, with the added advantage that the viruses are evolving to remain competitive against the bacteria at the same time bacteria are evolving to compete against them. In a series of studies done in the former Soviet Union by Slopek et al, researchers utilized a few select bacteriophages per patient to fight infections, including those caused by Staphylococci, Pseudomonas, Escherichia (E. Coli), Klebsiella, and Salmonella. The results were actually really good. Utilizing orally, topically, and mucosally administered lytic phages, they attempted to neutralize the infection. During the course of treatment, the researchers obtained cultures during both the symptomatic and post-symptomatic period to determine the presence or non-presence of the pathogen. Once negative cultures were obtained, they continued to administer the phage for 14 days, and if phage resistance was noted, then they switched phages. In the studies, success rates (determined by improvement concurrent with negative cultures) varied from 75% to 100%. In these studies, among 518 antimicrobial resistant infections, the success rate of antimicrobial phage therapy was near 94%. [4]Efficacy could potentially be boosted by attenuating bacteriophages to a person's individual strain of pathogenic bacteria, by administering phages as a cocktail, and/or by administering the phages concurrently with antimicrobial agents.

Unfortunately, the USDA's policy on phage therapy of any kind if very limited. I don't know why, perhaps because they feel that viruses are too poorly understood- and they aren't. The official policy on phage therapy in the United States maintains that any virus utilized pharmaceutically must be of one specific genome with no mutations allowed, and no cocktails allowed. What this translates into, when presented in the light of clinical trials in which phages cannot be swapped when resistance is noted, is not very good success rates. It also means that even if you did get a good success rate, we'd just circle back to our present chemical antimicrobial resistance issue.

There's more good news. With the encouragement of the CDC, a lot of hospitals are adopting antimicrobial stewardship programs, which are interdisciplinary teams of healthcare professionals that monitor antibiotic use to determine how appropriate the use of a given antibiotic is, viewed through the lens of the patient and the bacteria in question. It's a Band-Aid on the face of 'too little too late', but it will help slow the rise of antimicrobial resistance.
One of the best new hopes on the horizon for controlling resistant pathogens is the emerging science of the human microbiota. In and on all of us live trillions of bacteria, which can contribute to our health in exchange for us giving them some place safe to live. Research indicates that a healthy gut microbiota can contribute to controlling flare-ups of irritable bowel syndromes, ulcers, and even obesity (not to imply that an unhealthy microbiota is the cause of obesity). There's some speculation going on that a healthy microbiota may help prevent establishment of bacterial pathogens in your body.

What Can I Do?First and foremost, listen to your doctor. If you're prescribed antibiotics, take them, and take them all. Second, support science and public health research, and support politicians that support that. Third, practice good hygiene, such as washing your hands, regular showers, covering coughs and sneezes, etc. Avoid products that advertise that they contain antibiotics, and choose small-farm, locally raised livestock if possible. Get vaccinated, and follow the CDC on your social media network of preference- they'll provide you with accurate news and good suggestions when things are happening. The most important thing you can do is get educated on the subject, and share the knowledge you gain here.

 

 

 

1. http://stm.sciencemag.org/content/4/148/148ra116

2. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=41

3. http://www.ncbi.nlm.nih.gov/pubmed/17661706

4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC90351/

Hospitals

Before we begin, I'll beg your pardon for the very basic formatting and the irregular posts. I won't have access to a computer very regularly for a few weeks, so I'm having to do this by mobile.

 Your eyes do not deceive you. Today,we're talking about our much-acclaimed institutes of healing. What makes a hospital so scary, you ask? Well, it's not exactly the needles. How does a medical error fatality rate estimated at 210,000 in 2008 sound? That means that in 2008, an estimated 210,000 people in the United States' hospitals alone lost theirlives as a direct result of being hospitalized. [1] That puts medical errors above the CDC #3 (chronic low respiratory disease) cause for death for all age groups in their WISQARS system. The most common cause of fatality? Hospital acquired infection.[1][4]

Hospital acquired infections alone, at last surveillance, affect roughly 5.8 million people between the US and the EU- 1.7million in the US, 4.1 million in the EU.[2] In the US, in 2002, these infections accounted for 98,000 deaths. [3] I wasn't able to find much in the way of statistics to speak to how many of these infections carried some form of antimicrobial resistance. My suspicion is that most of them carried resistance to at least early generation antibiotics. Remember, though, that suspicions aren't facts. 

The truth of the matter is that hospitals still contribute significantly to your ability to survive a given trauma or medical incident- and they're getting better at it. I want you to check out source number five before you're done with this page. In 2000, there were 31.7 million hospitalizations and 776,000 inpatient deaths- compared to 2010 with 35.1 million hospitalizations and 715,000 inpatient (admitted patient) deaths. With four million extra patients, the inpatient death rate went down. A quick math experiment with those statistics will show that being admitted to the hospital only carries a 2% mortality rate, and they're not admitting people with scraped knees. Furthermore, while it's small solace, 75% of all hospital deaths occurred in people older than age 65, which means that it's happening mostly in people with multiple complicating medical conditions, on multiple medications, with bodily systems that, frankly, aren't what they used to be. In fact, for all causes of hospital admission, the inpatient death rates decreased, except for septicemia (systemic infection that spreads to and in the blood), which experienced a mortality rate increase of a whopping 17%. [5] I'd say that's less of an argument against the hospitals as it is an argument for the grave reality of antimicrobial resistance. 

So what can you do? As always, the most powerful tool in your arsenal is knowledge. If you or a family member is admitted, take the opportunity to learn about your condition by asking your doctor, your nurse, the Internet, or all of them. Nurses are stretched thin in a lot of hospitals, so be patient, patient, but also be involved in your care. If something doesn't seem right, if you notice something going on with you or something the hospital's doing (such as an unexpected medication) doesn't seem right, calmly notify your healthcare team of your concern, or ask for an explanation. Politely ask anyone who wants to touch you if they've cleaned their hands, and notify your nurse if you notice fever, chills, or other signs of infection. You can also help by writing or calling your legislature, or supporting bills or politicians that fund research, science, and public health. Talk to your friends and share what you've learned. Also, be sure to subscribe and share the blog with your friends. If you have questions, comments, concerns, or suggestions, feel free to comment here on the blog, or send me a message on my google plus account. 

5. http://www.cdc.gov/nchs/data/databriefs/db118.htm

4. (Page 7, numbers one and four) http://www.cdph.ca.gov/pubsforms/Pubs/OHIRmedicalcomps2000-2002.pdf

3. http://www.cdc.gov/HAI/pdfs/hai/infections_deaths.pdf

2. http://www.who.int/gpsc/country_work/summary_20100430_en.pdf

1. http://mobile.journals.lww.com/journalpatientsafety/_layouts/oaks.journals.mobile/articleviewer.aspx?year=2013&issue=09000&article=00002

Chickens

credit grandcentralbakery.com

 

Happy Holidays! I give you the gift of terror. What made six of the ten age group categories for the CDC's top ten causes of death in 2010? What killed over 300 kids in 2009, and killed over 100 Americans last year? [1] What has to be contained in a Biohazard Safety Level 4 facility, and killed anywhere from 20 million to 50 million people in 1918? [2] Well, it's not chickens, but they are relevant to the topic. The topic at hand is actually the respiratory virus Influenza. If you raised your eyebrows, you aren't alone.

Influenza is everywhere- you can find Influenza A viruses in dogs, seals, people, bats, ferrets, pigs, horses, and birds. Mainly, the viruses that can jump into people are found in pigs and birds, since we either are susceptible to the same Hemagglutinin (the H in H1N1 or H4N1) proteins, or their Hemagglutinin is close enough to fit our Sialic Acid (lung cell) receptors. When you then consider that influenza has a mutation rate just above one mutation per genome replication (1 in 10,000 base pairs mutate in a genome of roughly 13,000), and each infection of a complex organism results in billions of virus particles, it's pretty easy to imagine how easy it would be for a human-competent virus to arise from an animal infection. That same process of mutation contributes to antigenic drift, which essentially boils down to the idea that the virus I give you isn't the same virus I caught. Rinse and repeat a few hundred times, and you've got a virus that's different enough that last year's vaccine or immune memory can't touch it.

It gets better. Influenza has a segmented genome, which means that each of the segments undergoes transcription separately, and while it isn't totally random, the virus isn't guaranteed to package its segmented genome correctly when it leaves the cell. So what happens when you get two different influenza viruses infecting the same cell- like, say, a pig and bird influenza infecting the same pig lung tissue? You get antigenic shift, caused by reassortment. You get some of your genome from the bird flu- maybe the part that contributes to how pathogenic the virus is- and you get some of your genome from the pig flu- the part that makes it competent for spread in humans- and you've got a brand new virus that nobody's immune system knows how to handle.

It gets even better. Animal agriculture practices aren't really great anywhere, not even the US. Pigs, chickens, and other animals susceptible to infection with influenza are kept in the thousands in very close proximity to one another. You might suggest that they'd cull the sick ones, but, at least in people, not all contagious infected exhibit symptoms. At that, those that will exhibit symptoms can be contagious one day before they show any signs of infection. What that means is that poor ag practices can contribute to the mutation, spread, or rise of a pandemic influenza. That's pretty big revenge for such little chickens. 

So, we've got modern medicine, you say, who's afraid of the big bad flu? You have a small point for the moment- there's suspicion that a large number of the deaths from the 1918 Spanish Influenza were actually due to secondary bacterial pneumonia induced by the viral infection. We have antibiotics today, but maybe not for long. Antimicrobial resistance is another topic for another day, but to put it bluntly, in an interview with PBS, an associate director at the CDC stated in October 2013 that "We're in the post-antibiotic era."[3] So, we're at real risk for secondary pneumonias. So far, we've gotten lucky with bird influenzas like H7N9 or H4N1, which seem to sacrifice their ability to spread for pathogenicity, demonstrating only stuttering chains of transmission among family or persons with very close contact. Our luck is eventually going to run out, if history is any lesson.

 

Fight the Fear

So, now that you're thoroughly alarmed, let's talk about what we've got fighting in our corner. First, and foremost, influenza itself. It may come as something of a surprise, but the virus typically has a pretty low R0 (R-naught, also known as the reproductive number, indicates how many subsequent infections arise on average from each infection) somewhere near 1.4 [4]. For example, if there's 100 infected with a disease with an R0 of 1.4, they'll create 140 new infections during the course of their own infection. For reference, any virus with an R0 below 1 will fail in a population, and smallpox had an R0 around 3. What that means is that, with the proper application of pharmaceutical an public health interventions, containing a pandemic influenza might be within our grasp.

In the realm of pharmaceutical interventions, we have a few tools at our disposal. We have antivirals that we can use to reduce the impact and duration of an influenza infection, but not all strains are susceptible to currently available therapies, and it is possible to cause a pandemic flu to develop resistance to antivirals if they're overused or deployed inappropriately. We also have vaccines available, but their efficacy is often variable due to antigenic drift, which can allow the virus to escape a vaccine-induced immunity. Unlike with antivirals, however, vaccines are generally believed to be more effective the more they're used, because they limit the spread- thus, the opportunities the virus has to mutate- of a pathogen through a population. If you reduce the number of available hosts for a virus, you reduce the R0, and if you bring it below 1, you can bring the epidemic to a halt. However, if vaccine compliance in a population is poor, it can contribute to a pathogen escaping vaccine induced immunity by exposing the vaccinated population to viable mutants, and those among the vaccinated population who do not develop lasting immunity and would otherwise be protected through a phenomenon known as herd immunity.

Our biggest aid in preventing the rise of pandemic influenza is research and public health monitoring programs, such as the NIH and the CDC, respectively. Researchers are currently in the process of developing a vaccine that targets fundamental parts of the virus that don't tolerate mutation very well [5]. They're also doing basic research to find out what parts of the virus contribute to infectivity and pathogenesis, in hopes that we'll be able to use that information to develop drugs to target them. Public health programs monitor for new infections, and have multiple measures at their disposal- such as quarantines, isolation, travel restrictions, culling livestock, and mass media announcements- to try and slow or shut down an epidemic. Wikipedia has a wonderful timeline detailing the various public health measures that were taken to bring the 2003 SARS epidemic to a halt here.

 

What Can I Do?

Get vaccinated. The numbers aren't phenomenal for seasonal flu vaccine success rates, usually hovering somewhere around 70%, but that's still better than no protection at all. Even if you do get sick, it can still help lessen your symptoms and shorten the duration of your infection. More importantly, it helps limit the spread of seasonal flu through the rest of the population, which will afford protection to children, the elderly, the infirm, and the immunocompromised (like AIDS, some cancer, and transplant patients). If you think you have the flu, stay home, wear a mask if you have to go out in public, and sneeze into the pit of your elbow to keep from launching influenza particles up to six feet away from you. Washing your hands with soap and water frequently (or using hand sanitizer) and teaching yourself not to touch your face can also be effective ways to reduce your risk of catching, and thus, spreading the Flu. Also, don't go to your doctor demanding antibiotics, because they won't help. The Flu is a virus, not a bacteria, and isn't affected in the slightest. You wouldn't take Benadryl for a sprained ankle, and you don't take antibiotics for a viral illness- the only thing you'll be doing is contributing to the growing antibiotic resistance problem.

You can also help by promoting healthy agriculture practices. There's a number of good organizations out there that aren't PETA, and actually get things done by working with- not against- people. A good place to start is the FAO. You can write to your local legislature or support politicians or bills that seek to improve agricultural standards. If you're going to buy a pet bird, try to verify that the animal came from a local breeder instead of overseas. There's a large black market for exotic animals, and we're throwing the dice every time one of these animals gets imported without the proper quarantine measures. Try eating some vegetables once in a while, or buying from farmer's markets- if demand for meat slows, fewer livestock will be required to meet the demand, which will hopefully translate to less cramped conditions for livestock, like chickens. If our feathered overlords are pleased with these offerings, we may delay a pandemic a little while longer.

You can push for more funding to public health and research programs, and donate to science projects you believe in through crowdfunding sites, such as indiegogo. The biggest impact here comes from sharing the knowledge. Get educated on the flu at http://www.cdc.gov/flu/index.htm and share what you've learned here.

 

 

 

 

Sources & Citations

1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6223a5.htm

2. http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/bulletin_of_the_history_of_medicine/v076/76.1johnson.html

3. http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/dr-arjun-srinivasan-weve-reached-the-end-of-antibiotics-period/

4. http://www.ncbi.nlm.nih.gov/m/pubmed/19545404/

5. http://mbio.asm.org/content/1/1/e00018-10.full

http://www.aphis.usda.gov/publications/animal_health/content/printable_version/poster_ah_bird_flu_ad_.pdf