Published by
Stanford Medicine

Category

In the News

CDC, In the News, Infectious Disease, Neuroscience, Pediatrics

Stanford experts offer more information about enterovirus-D68

Stanford experts offer more information about enterovirus-D68

Below is an updated version of an entry that was originally posted on Sept. 26.

SONY DSCLast week, the California Department of Public Health confirmed that the season’s first four cases of enterovirus-D68 respiratory illness had been found in the state, three in San Diego County and one in Ventura County, with more expected to surface. As of Sept. 29, this makes California one of 40 states across the nation to be affected by EV-D68.

Health officials in Colorado are now investigating a handful of cases of paralysis in children there; the paralysis began a few weeks after respiratory illness and appears to be connected to EV-D68. Since the same virus was tentatively linked to paralysis cases in California children earlier this year, California officials are monitoring the situation closely.

Below, Yvonne Maldonado, MD, service chief of pediatric infectious disease at Lucile Packard Children’s Hospital Stanford, answers additional questions about the respiratory symptoms caused by this virus. Keith Van Haren, MD, a pediatric neurologist who has been assisting closely with the California Department of Public Health’s investigation, also comments on neurologic symptoms that might be associated with the virus.

Enteroviruses are not unusual. Why is there so much focus from health officials on this one, EV-D68?

Maldonado: The good news is that this virus comes from a very common family of viruses that cause most fever-producing illnesses in childhood. But it’s been more severe than other enteroviruses. Some hospitals in other parts of the country have had hundreds of children coming to their emergency departments with really bad respiratory symptoms. The fact that it’s been so highly symptomatic and that there has been a large volume of cases is why it has gotten so much attention.

Van Haren: It’s important to remember that most children and adults who are exposed to enteroviruses don’t get sick at all. A smaller percentage come down with fever and/or respiratory symptoms, as Dr. Maldonado has described. And as far as we can tell, it’s only a very, very small number of children, if any, who get paralysis, typically affecting one arm or leg. The Centers for Disease Control and the California Department of Public Health are still investigating to try to determine conclusively whether EV-D68 is causing neurologic symptoms, such as paralysis.

What do we know about the course of possible neurologic symptoms of EV-D68 and their potential treatments?

Van Haren: We’re still learning about the possible neurologic symptoms and how we might treat them. To start, we have a growing suspicion that EV-D68 may be associated with paralysis. In the patients we’ve seen with paralysis, progression of weakness appears to stop on its own, and recovery of strength is very slow and usually incomplete.

Which groups are most at risk?

Maldonado: Children with a history of asthma have been reported to have especially bad respiratory symptoms with this virus. It can affect kids of all ages, from infants to teens. So far, only one case has been reported in an adult, which makes sense because adults are more likely to have immunity to enteroviruses. We do worry more about young infants than older children, just because they probably haven’t seen the virus before and can get worse respiratory symptoms with these viral infections.

Van Haren: We don’t yet know who is most at risk for paralysis or other neurologic symptoms, but we are studying this carefully to find out why some children get sick and some do not. So far, it seems that the children who have been affected by paralysis were generally healthy prior to their illness.

What is the treatment for EV-D68?

Maldonado: There is no treatment that is specific to the virus. At home, parents can manage children’s fevers with over-the-counter medications, make sure they drink lots of fluids to avoid dehydration, and help them get plenty of rest. For children who are very ill, doctors will check for secondary illnesses such as bacterial pneumonia, which would be treated with antibiotics, and may hospitalize children who need oxygen or IV hydration to help them recover.

Continue Reading »

Applied Biotechnology, Genetics, In the News, Nutrition, Public Health, Research

“Frankenfoods” just like natural counterparts, health-wise (at least if you’re a farm animal)

"Frankenfoods" just like natural counterparts, health-wise (at least if you're a farm animal)

cow2More than a hundred billion farm animals have voted with their feet (or their hoofs, as the case may be). And the returns are in: Genetically modified meals are causing them zero health problems.

Many a word has been spilled in connection with the scientific investigation of crops variously referred to as “transgenic,” “bioengineered,” “genetically engineered” or “genetically modified.” In every case, what’s being referred to is an otherwise ordinary fruit, vegetable, or fiber source into which genetic material from a foreign species has been inserted for the purpose of making that crop, say, sturdier or  more drought- or herbicide- or pest-resistant.

Derided as “Frankenfoods” by critics, these crops have been accused of everything from being responsible for a very real global uptick in allergic diseases to causing cancer and autoimmune disease. But (flying in the face of the first accusation) allergic disorders are also rising in Europe, where genetically modified, or GM, crops’ usage is far less widespread than in North America. It’s the same story with autoimmune disease. And claims of a link between genetically modified crops and tumor formation have been backed by scant if any evidence; one paper making such a claim  got all the way through peer review and received a fair amount of Internet buzz before it was ignominiously retracted last year.

But a huge natural experiment to test GM crops’ safety has been underway for some time. Globally, between 70 and 90 percent of all GM foods are consumed by domesticated animals grown by farmers and ranchers. More than 95 percent of such animals – close to 10 billion of them – in the United States alone consume feed containing GM  components.

This was, of course, not the case before the advent of commercially available GM feeds in the 1990s. And U.S. law has long required scrupulous record-keeping concerning the health of animals grown for food production. This makes possible a before-and-after comparison.

In a just-published article in the Journal of Animal Science, University of California-Davis scientists performed a massive review of data available on performance and health of animals consuming feed containing GM ingredients and  products derived from them. The researchers conclude that there’s no evidence of GM products exerting negative health effects on livestock. From the study’s abstract:

Numerous experimental studies have consistently revealed that the performance and health of GE-fed animals are comparable with those fed [otherwise identical] non-[GM] crop lines. Data on livestock productivity and health were collated from publicly available sources from 1983, before the introduction of [GM] crops in 1996, and subsequently through 2011, a period with high levels of predominately [GM] animal feed. These field data sets representing over 100 billion animals following the introduction of [GM]crops did not reveal unfavorable or perturbed trends in livestock health and productivity. No study has revealed any differences in the nutritional profile of animal products derived from[GM]-fed animals.

In other words, the 100 billion GM-fed animals didn’t get sick any more frequently, or in different ways. No noticeable difference at all.

Should that surprise us? We humans are, in fact, pretty transgenic ourselves. About 5 percent of our own DNA can be traced to viruses who deposited their  genes in our genomes, leaving them behind as reminders of the viral visitations. I suppose that’s a great case against cannibalism if you fear GM foods. But I can think of other far more valid arguments to be made along those lines.

Previously: Ask Stanford Medicine: Pediatric immunologist answers your questions about food allergy research, Research shows little evidence that organic foods are more nutritional than conventional ones and Stanford study on the health benefits of organic food: What people are saying
Photo by David B. Gleason

Big data, In the News, Patient Care, Pediatrics, Stanford News

Examining the potential of big data to transform health care

Examining the potential of big data to transform health care

Back in 2011, rheumatologist Jennifer Frankovich, MD, and colleagues at Lucile Packard Children’s Hospital Stanford used aggregate patient data from electronic medical records in making a difficult and quick decision in the care of a 13-year-old girl with a rare disease.

Today on San Francisco’s KQED, Frankovich discusses the unusual case and the potential of big data to transform the practice of medicine. Stanford systems-medicine chief Atul Butte, MD, PhD, also weighed in on the topic in the segment by saying, “The idea here is [that] the scientific method itself is growing obsolete.” More from the piece:

Big data is more than medical records and environmental data, Butte says. It could (or already does) include the results of every clinical trial that’s ever been done, every lab test, Google search, tweet. The data from your fitBit.

Eventually, the challenge won’t be finding the data, it’ll be figuring out how to organize it all. “I think the computational side of this is, let’s try to connect everything to everything,” Butte says.

Frankovich agrees with Butte, noting that developing systems to accurately interpret genetic, medical or other health metrics is key if such practices are going to become the standard model of care.

Previously: How efforts to mine electronic health records influence clinical care, NIH Director: “Big Data should inspire us”, Chief technology officer of the United States to speak at Big Data in Biomedicine conference and A new view of patient data: Using electronic medical records to guide treatment

Addiction, In the News, Public Health

Stanford experts skeptical about motives behind e-cigarette health warnings

11359245033_0a05d9c884_z

Quotes can sometimes make or break a news article. I was skimming a New York Times article on new, harsh health warnings from tobacco companies when a quote from Stanford otolaryngologist Robert Jackler, MD, stopped me in my tracks.

“When I saw it, I nearly fell off my chair,” Jackler told the Times. What made a renowned expert in tobacco advertising fall off his chair? I was hooked (and not on cigarettes, thankfully) and had to keep reading.

It turns out that Jackler had spotted the warning on MarkTen e-cigarette packs, which details many of the deleterious effects of nicotine, calling it “very toxic by inhalation, in contact with the skin, or if swallowed.” The product is not to be used by children, women who are pregnant or breast-feeding, anyone with heart disease or high blood pressure, or those taking medication for depression or asthma. The list goes on.

These warnings are voluntary, explained the Times‘ Matt Richtel, who also wrote:

Experts with years studying tobacco company behavior say they strongly suspect several motives, but, chiefly, that the e-cigarette warnings are a very low-risk way for the companies to insulate themselves from future lawsuits and, even more broadly, to appear responsible, open and frank. By doing so, the experts said, big tobacco curries favor with consumers and regulators, earning a kind of legitimacy that they crave and have sought for decades. Plus, they get to appear more responsible than the smaller e-cigarette companies that seek to unseat them.

The tobacco companies say they are striving to be honest and open. With another choice quote, Stephanie Cordisco, president of the R. J. Reynolds Vapor Company, told the Times: “We’re here to make sure we can put this industry on the right side of history.”

Not so, Stanford science historian Robert Proctor, PhD, responded. He called the voluntary warnings “totally Orwellian.”

“They do everything for legal reasons, otherwise they’d stop making the world’s deadliest consumer products,” Proctor said.

Becky Bach is a former park ranger who now spends her time writing about science and practicing yoga. She is an intern in the Office of Communications and Public Affairs. 

Previously: How e-cigarettes are sparking a new wave of tobacco marketing, E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher and What the experience of Swedish snuff can teach us about e-cigarettes
Photo by Lindsay Fox

Evolution, In the News, Research, Stanford News

Blond ambition: Delving into the work of Stanford biologist David Kingsley

Blond ambition: Delving into the work of Stanford biologist David Kingsley

Thanks to a tiny fish called the stickleback, Stanford developmental biologist David Kingsley, PhD, and his team uncovered the genetic basis for blond hair earlier this year.

Kingsley’s research caught the eye of the team at HHMI Bulletin, which featured his discovery in their fall issue. As described in the piece, Kingsley and fellow researcher Catherine Guenther, PhD, discovered the change in a single point in the genetic sequence outside the gene itself. The discovery prompted a question because the gene, known as KITLG, is involved in many other key processes in developing organisms. Yet Kingsley found the control for hair color acted alone.

“The genetic mechanism that controls blond hair doesn’t alter the biology of any other part of the body. It’s a trait that’s skin deep, and only skin deep,” Kingsley told HHMI.

The HHMI feature also includes a video of Kingsley – above – that provides glimpses into his lab and reveals the sources of his inspiration (as well as his penchant for purchasing telescopes).

And for a Friday giggle, check out his lab members spelling his name with their bodies here.

Becky Bach is a science-writing intern at the Office of Communications and Public Affairs. 

Previously: It’s a blond thing: Stanford researchers suss out molecular basis of hair color, Something fishy: Threespine stickleback genome published by Stanford researchers and Hey guys, sometimes less is really more

Cancer, Clinical Trials, In the News, NIH, Patient Care, Research

National Cancer Institute looking for “Exceptional Responders”

OLYMPUS DIGITAL CAMERAHope is a powerful force in cancer treatment. For patients and their families, the hope is that, no matter how unlikely, the treatment plan will cure the patient and eradicate the disease. Sadly, this is sometimes a long shot. But sometimes, against all odds, the therapy is unusually successful. Now the National Cancer Institute is trying to learn why.

This week the institute launched a study into the phenomena of “Exceptional Responders” – that is, cancer patients who have a unique response to treatments (primarily chemotherapy) that have not been effective for most other patients. As they describe in a Q&A about the effort:

For this initiative, exceptional responders will be identified among patients enrolled in early-phase clinical trials in which fewer than 10 percent of the patients responded to the treatments being studied; patients who were treated with drugs not found to be generally effective for their disease; patients who were treated in later-phase clinical trials of single agents or combinations; and even patients who were treated with established therapies. In this pilot study, malignant tissue (and normal tissue, when possible) and clinical data will be obtained from a group of exceptional responders and analyzed in detail. The goal is to determine whether certain molecular features of the malignant tissue can predict responses to the same or similar drugs.

The researchers would like to obtain tumor samples, as well as normal tissue, from about 100 exceptional responders. They’ll compare DNA sequences and RNA transcript levels and other molecular measurements to try to understand why these patients were such outliers in their response to treatment. In at least one previous case, an exceptional responder with bladder cancer led researchers to discover a new molecular pathway involved in the development of the disease, and suggested new therapeutic approaches for other similar patients.

Do you know someone who might qualify for the study? More from the Q&A:

Patients who believe they may be exceptional responders should contact their physicians or clinical trialists to see if they can assist in submitting tissue for consideration. [...] Investigators who have tissue from a potential exceptional responder should send an email to NCIExceptionalResponders@mail.nih.gov. The email should include a short description of the case, without patient identifiers; information about whether tissue collected before the exceptional response is available; whether informed consent was given to use tissue for research; and the patient’s vital status.

Photo by pol sifter

CDC, In the News, Infectious Disease, Pediatrics, Public Health

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

SONY DSCToday’s New York Times features a story on the accelerating spread of enterovirus-D68, a virus that is causing severe respiratory illness in children across the country. As the Times reports, some emergency departments in the Midwest have been so swamped with cases that they’ve had to divert ambulances to other hospitals. Although California is still only lightly affected, the state’s first four cases were confirmed by the California Department of Public Health late last week, with more expected to surface.

To help parents who may be wondering how to prevent, spot and care for EV-D68 infection, Yvonne Maldonado, MD, service chief of pediatric infectious disease at Lucile Packard Children’s Hospital Stanford, answered some common questions about the virus:

Enteroviruses are not unusual. Why is there so much focus from health officials on this one, EV-D68?

The good news is that this virus comes from a very common family of viruses that cause most fever-producing illnesses in childhood. But it’s been more severe than other enteroviruses. Some hospitals in other parts of the country have had hundreds of children coming to their emergency departments with really bad respiratory symptoms. The fact that it’s been so highly symptomatic and that there has been a large volume of cases is why it has gotten so much attention.

Have any patients at Lucile Packard Children’s Hospital Stanford been affected with EV-D68?

As of today (Sept. 26), we have not yet had a documented case at our hospital. However, there have been a total of 226 confirmed cases in 38 states across the country. Some children who have this virus are probably not being tested, so the real number of cases nationwide is likely to be higher.

If your child has respiratory symptoms and you suspect EV-D68, what should you do?

The virus causes symptoms such as coughing, sneezing and runny nose. In some cases but not all, kids also have a fever. If your child has respiratory symptoms with or without a fever, especially if he or she also has a history of asthma, monitor your child at home. If you feel that he or she has been sick for a long period, is getting worse or is experiencing worsening of asthma or difficulty breathing, go see your pediatrician.

Which groups are most at risk?

Children with a history of asthma have been reported to have especially bad respiratory symptoms with this virus. It can affect kids of all ages, from infants to teens. So far, only one case has been reported in an adult, which makes sense because adults are more likely to have immunity to enteroviruses. We do worry more about young infants than older children, just because they probably haven’t seen the virus before and can get sicker with these viral infections.

How can the illness be prevented?

This virus is spread by contact with secretions such as saliva. If your children are sick, they should stay home from school to avoid spreading the illness to others. To avoid getting sick, stay at least three feet from people with symptoms such as coughing and runny nose, wash your hands frequently, and make sure your kids wash their hands often, too.

What is the treatment for EV-D68?

There is no treatment that is specific to the virus. At home, parents can manage children’s fevers with over-the-counter medications, make sure they drink lots of fluids to avoid dehydration, and help them get plenty of rest. For children who are very ill, doctors will check for secondary illnesses such as bacterial pneumonia, which would be treated with antibiotics, and may hospitalize children who need oxygen or IV hydration to help them recover.

Previously: Tips from a child on managing asthma
Photo by Michelle Brandt

Health Costs, Health Policy, In the News, Media, Medicine and Society, NIH

#ACT4NIH campaign seeks stories to spur research investment

#ACT4NIH campaign seeks stories to spur research investment

ACT4NIH_Samples_FINAL

No ice buckets are involved in the latest push for investment in medical research. Instead Act for NIH: Advancing Cures Today, a Washington D.C.-based non-profit led by a former National Institutes of Health staffer, is a good ‘ol fashioned media campaign using data, stories and images, including a haunting photo of a presumably sick child captaining its home page.

The need is real. NIH funding has failed to keep pace with inflation or with investments by other nations including China. Now, only one in six research proposals, the lowest ever, are accepted, according to Act for NIH.

The campaign’s goal is simple: “We advocate an immediate, significant funding increase for the NIH, followed by steady, predictable budget growth in the future.”

Not so simple, of course, is the actual funding hike. That’s why the campaign is hunting for stories, as well as money. It urges supporters to photograph themselves besides a ACT for fill-in-the-blank poster. ACT for cancer, for hope, my grandfather, for AIDS – you name the reason to support research, action (and money) is needed.

Science released an interview with leader Patrick White today. White admitted the group lacks a formal plan, but it does have momentum, thanks to the backing by real estate developers Jed Manocherian.

It’s launch comes just in time for the 2015-16 federal budget cycle, which usually begins with the president’s budget proposal in February.

Becky Bach is a former park ranger who now spends her time writing about science and practicing yoga. She’s an intern with the Office of Communications and Public Affairs. 

Previously: How can health-care providers better leverage social media to improve patient care?, NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases and Federal investments in research and higher education key to U.S. maintaining innovation edge
Photo by Act for NIH

CDC, Ebola, Events, Global Health, In the News, Infectious Disease

Ebola panel says 1.4 million cases possible, building trust key to containment

Ebola panel says 1.4 million cases possible, building trust key to containment

ebola workers2The Ebola epidemic is spreading rapidly – leaving a wake of suffering – in large part because West Africa has shockingly few medical facilities or trained personnel. But it’s exploding exponentially because of mistrust, a panel of experts told a packed crowd on the Stanford campus last evening.

The numbers, as described by Ruthann Richter in a just-published story, are sobering:

Officially, more than 5,800 Ebola cases and 2,800 deaths from the disease have been reported in four countries: Liberia, Guinea, Sierra Leone and Nigeria. But panelists said those figures were vastly underestimated. At the current rate of spread, in which the number of new infections is doubling every three weeks, the U.S. Centers for Disease Control and Prevention estimates that 1.4 million people could be infected by the end of January 2015 in the absence of dramatic interventions, said Douglas Owens, MD, a professor of medicine and director of the Center for Health Policy at Freeman Spogli Institute of International Studies.

But even with “very aggressive” intervention, Owens said, it’s estimated there would be at least 25,000 cases by late December. If intervention is delayed by just one month, there will be 3,000 new cases every day; if it’s delayed by two months, there will be 10,000 new cases daily, he said. “It gives you a sense of the extraordinary urgency in terms of time,” Owens told the audience.

During the talk Stanford health-policy expert Paul Wise, MD, screened a CNN video that depicts a man escaping from a treatment facility in Liberia. “You have to create treatment centers that are of the highest quality and that treat people with dignity — so people will want to go there, rather than escape,” he said.

Building trust starts local, Tara Perti, MD, told the audience. She works as a CDC epidemic intelligence service officer and spent time in both Guinea and Sierra Leone this summer:

In Guinea, she traveled to a village north of the capital city of Conakry, where she met two young men who had recovered from the disease, which has a fatality rate as high as 70 percent. One of the men had lost five members of his family, but he had become a community advocate. He traveled with Perti to a neighboring village, where they met a woman who was sick and whose son had died of the disease. “She was very fearful of going to the treatment center… but she was ultimately convinced to seek treatment. She recovered and was able to return home,” Perti said.

“The patient who survived was tremendously helpful because he could speak from experience and be credible. There needs to be more of these. In the forested region of Guinea, there are a lot of superstitions and different beliefs besides germ theory, and so it’s very challenging to go into those areas and help people understand that Ebola is a virus, it’s real and we do have ways to help patients.”

The world’s disjointed response to the epidemic points points to the need for global-health reforms, Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health, concluded.

Becky Bach is a former park ranger and newspaper reporter who now writes about science as an intern at the Office of Communications and Public Affairs. 

Previously: Interdisciplinary campus panel to examine Ebola outbreak from all angles, Expert panel discusses challenges of controlling Ebola in West Africa, Should we worry? Stanford’s global health chief weighs in on Ebola and Biosecurity experts discuss Ebola and related public health concerns and policy implications
Photo, of health workers at an Ebola treatment unit in Liberia, by USAID/Morgana Wingard

In the News, Public Health

Healthy gut bacteria help chicken producers avoid antibiotics

Healthy gut bacteria help chicken producers avoid antibiotics

chicks for productionIf you watch TV, you’ve probably seen actress Jamie Lee Curtis selling Activa, Dannon’s probiotic yogurt – or perhaps you’ve  taken probiotic supplements to help you recover after a nasty intestinal infection. Probiotics are microorganisms that are thought to help improve the bacterial balance in our guts. It’s not clear whether they are effective in humans, but they do appear to work in chickens.

Recently, the third-largest chicken producer in the nation, Perdue Farms, announced that it had eliminated almost all antibiotics from its farm operations – a move that has been in the works at the company for a dozen years. As NPR’s The Salt blog recently reported, the company has turned, instead, to probiotics to help keep the chickens healthy:

“As we took antibiotics out of the feed, we put some other things in, such as probiotics,” says Bruce Stewart-Brown, an executive at Perdue Farms. “We’ve increased the amount of probiotics by five times over the past five years. It’s a significant part of our program.”

Since the 1970s, farmers have given low doses of antibiotics to livestock animals to help them grow faster and bigger, a practice called “sub-therapeutic” use. And for almost as long, the practice has been viewed with suspicion by many concerned that it may encourage antibiotic resistance. Approximately 15-17 million pounds of antibiotics are given to livestock in the U.S. every year, according to Stuart Levy, MD, of Tufts University, director of the Alliance for the Prudent Use of Antibiotics.

In December, the FDA asked antibiotic producers to label their drugs so that they did not promote “sub-therapeutic” doses to fatten animals and earlier this month, the White House issued a report on combatting antibiotic resistance. One of the criticisms of the plan was that it didn’t make strong recommendations for reducing sub-therapeutic use of antibiotics in livestock animals.

Probiotics are a more expensive intervention than sub-therapeutic antibiotics, but offer an alternative – at least in chickens, as The Salt reports:

Stewart-Brown says that he was initially skeptical about probiotics. “Eight years ago, I would have said that they’re not working in poultry. They’re not very useful. Today, I’m saying that they are useful. Expensive, but useful. “Chickens that got probiotics stayed healthier and grew faster than birds that didn’t.

Perdue’s experiment with probiotics is probably the largest of its kind among commercial producers. How they fare may be a bell weather of what’s to come for other agricultural livestock producers and provide them with a route away from antibiotic overuse.

Previously: Interactive online map helps researchers track spread of antibiotic-resistant bacteria and Some unlikely sources for antibiotics
Photo by Loaf

Stanford Medicine Resources: