Published by
Stanford Medicine


Infectious Disease

Infectious Disease, Public Health, Stanford News

Experts and 8-year-olds agree: It’s worth getting a flu shot

Experts and 8-year-olds agree: It's worth getting a flu shot

smiley faceIf you’re around my young daughters these days and happen to mention the flu shot, you’re likely to get an earful. “We got ours too late last year and got really sick,” they’ll tell you (as I look down in embarrassment). “It’s really important to get one.” They also, not surprisingly, were not at all upset when I made an appointment – nice and early! – for them to get vaccinated a few weeks ago. They knew it would hurt, but in the words of my 8-year-old, “it’s worth it.”

My girls – the walking pro-flu shot billboards that they are – were the first people I thought of when I came across a Stanford BeWell article this week on – you guessed it – the importance of flu shots. In the piece, infectious disease expert Cornelia L. Dekker, MD, answers questions about influenza and last year’s flu vaccine (which failed to protect people against several strains of the flu), and she reminds local readers that shots are being offered on campus for students, staff and faculty for free.

Previously: How one mom learned the importance of the flu shot – the hard way and Ask Stanford Med: Answers to your questions about seasonal influenza
Photo by cignoh

Infectious Disease, Microbiology, Research, Stanford News

Why C. difficile-defanging mouse cure may work in people, too

Why C. difficile-defanging mouse cure may work in people, too

CdiffI wrote a news release last week about a study just published in Science Translational Medicine. The study, despite it having been conducted in mice, not humans, received a fair amount of coverage – by The Washington Post, Yahoo!, Fox News, NBC, CBS and Reuters, among other places – and deserved the attention it got. It demonstrated the efficacy of a small-molecule drug that can disable the nasty intestinal pathogen C. difficile without killing it – and, importantly, without decimating the “good” bacteria that populate our gut by the trillions.

That’s a big deal. If you want to see a lot of ugly weeds pop up, there’s no better way to go about it than letting your lawn go to hell.

C. difficile – responsible for more than 250,000 hospitalizations and 15,000 deaths per year in the United States and a $4 billion annual health-care tab in the U.S. alone – is typically treated by antibiotics, which have the unfortunate side effect of wiping out much of our intestinal microbe population. That loss of carpeting, ironically, lays the groundwork for a dangerous and all-too-common comeback of C. difficile infection.

A question worth asking about this study, conducted by what-makes-pathogens-tick expert Matt Bogyo, PhD, and a team of Stanford associates: Why should we think that what works in mice is going to work in people?

The only sure answer isn’t a torrent of language but a clinical trial of the drug, ebselen, in real, live people with C. difficile infections or at risk for them. (Bogyo has already started accumulating funding to initiate a trial along those lines.)

But there’s also reassurance to be drawn from the fact that ebselen isn’t an entirely exotic newcomer to the world of medical research. As I noted in my release:

Bogyo and his associates focused on … ebselen because, in addition to having a strong inhibitory effect, ebselen also has been tested in clinical trials for chemotherapy-related hearing loss and for stroke. Preclinical testing provided evidence that ebselen is safe and tolerable, and it has shown no significant adverse effects in ensuing clinical trials.

Continue Reading »

Bioengineering, Cancer, Infectious Disease, Precision health, Research, Stanford News

Stanford scientists co-opt viral machinery to create medical delivery system

Stanford scientists co-opt viral machinery to create medical delivery system

James Swartz

Stanford engineering researcher James Swartz, PhD, and his colleagues have remodeled a hepatitis B virus to turn it into a microscopic taxi for medical therapies. The team stripped the virus of its pathogenic DNA and modified an outer shell so that they could “hang” molecular tags on the outside to help deliver vaccines or other therapies to specific cells. The researchers reported their findings in a paper in the scientific journal Proceedings of the National Academy this week.

They call the engineered product a virus-like particle (as opposed to a real virus with infectious material) or a smart particle. “We make it smart by adding molecular tags that act like addresses to send the therapeutic payload where we want it to go,” Swartz said in a Stanford News story.

The smart particle is a novel way to deliver vaccines or cancer therapies by teaching the body’s immune cells to recognize pathogens or cancer cells. Alternatively, the smart particle can deliver medicine specifically to the cells that need it.

Swartz and his colleagues’ effort is part of a larger field of targeted therapies that aims to precisely deliver therapies to the cells that need them and avoid damaging nearby healthy cells. Current cancer therapies, for example, are effective at fighting malignant cells, but also kill off healthy cells. That’s why cancer therapies often have such devastating side effects. But previous attempts to create virus-sized delivery systems have not been successful. In fact, Swartz’s team had a hard time getting funding for the early stages of this project because of previous failed efforts by other scientists.

So far, Swartz and colleagues have created the self-assembling shell that is invisible to the body’s natural immune defenses and strong enough to weather conditions in the blood stream and get its packaged contents to its destination inside the body. Next, they’ll work on putting specific cancer-fighting tags on the shell.

The most challenging task will be to pack the shell with a tiny dose of medicine. But Swartz sounded optimistic about his team’s goals. “I believe we can use this smart particle to deliver cancer-fighting immunotherapies that will have minimal side effects,” he said.

Previously: A less toxic, targeted therapy for childhood brain cancerIs cancer too complex for targeted therapies? and Working to create a universal flu vaccine
Photo, of Swartz holding an enlarged replica of a virus-like particle, by Linda Rice

Global Health, Health Policy, HIV/AIDS, Infectious Disease

From Bollywood actress to social activist

From Bollywood actress to social activist

TeachAIDS classDuring a recent trip to India, I had the great fortune to spend the day with Amala Akkineni, a beloved south Indian actress who is using her celebrity to advance the greater public good.

A trained dancer and once a major Bollywood star, Akkineni has turned her attentions in the last few decades to the nonprofit world, where she works on behalf of women and girls, people with HIV/AIDS and other vulnerable members of society.

She is still a widely recognized movie idol, attracting gawkers and autograph seekers wherever we went in Hyderabad, a south Indian city of some 7 million people. Despite her fame, she is a modest woman, who dressed simply that day in a blue cotton sari, delicate necklace and no make-up as she took us on a tour of some of the many social projects that are dear to her heart.

I met Akkineni through a friend at Stanford, Piya Sorcar, PhD, who founded a remarkably successful project, TeachAIDS, which began as her graduate thesis in the School of Education. The nonprofit disseminates video materials around the globe, using animated figures of well-known celebrities to convey simple messages about transmission, treatment and prevention of HIV/AIDS. The videos are now available in 81 countries and in 14 languages, including 7 dialects common in India, where AIDS is still a major public health problem.

Akkineni first took us to her nonprofit, Blue Cross of Hyderabad, an animal shelter that she founded in 1992 after her garage had filled up with disabled and abused creatures she had rescued from streets and homes in Hyderabad. Akkineni works regularly at the shelter and is not afraid to get her hands dirty as she comforts dogs with missing legs or feeds camels rescued from the slaughterhouse.

As she became known in Hyderabad for her work with animals in the 1990s, she was approached by Karl Sequeira, an activist in the world of AIDS and addiction, who wanted her help in starting a hospice for AIDS patients. “I was already known as this notorious ex-actress who was running this hospice for animals. So he thought I was a kindred soul,” she told me in an interview in her small office at the shelter. At the time, HIV/AIDS was such a stigmatized condition that people with full-blown disease were literally being tossed in the trash, she said. “AIDS was everywhere but nobody knew how to deal with it. It was spreading like wildfire,” she told me. She, Sequeira and other activists raised enough in one evening to open an AIDS hospice run by the Freedom Foundation, which offers a wide range of HIV services today (Sequeira died in 2004).

Continue Reading »

Aging, In the News, Infectious Disease, Public Health, Research

Does the flu vaccine really help the elderly?

EM_of_influenza_virusMost years, senior citizens are among the groups hit hardest by flu, which is why doctors recommend all people over 65 get vaccinated. But accurately measuring how well the vaccine does at preventing severe disease and deaths isn’t as straightforward as it is in younger populations.

A lot of factors complicate getting accurate information on the number of flu cases among older adults and the vaccine’s role at preventing them, and some have argued that current estimates of the flu vaccine’s effectiveness are overblown because they don’t account for such factors. For example, sometimes patients are left unvaccinated because they are already medically frail and struggling with a lot of other health issues. So simply counting the number of deaths among unvaccinated patients versus vaccinated patients might not paint an accurate picture.

Last month, a study led by Vincent Mor, PhD, of Brown University, looked a little closer at the vaccine to assess its effectiveness. The research team analyzed 10 years of Medicare claims for nursing home residents, taking advantage of a built-in variation.

Because the flu virus changes over time, the vaccine has to be updated every year to fight against the strains that are circulating that year. Some years, the vaccine matches what’s circulating better than other years. (Last year, in the 2014-2015 season, the vaccine strain didn’t match the flu viruses infecting people very well.)

If the vaccine isn’t effective in elderly patients, then we shouldn’t see any difference in flu cases from year to year. But Mor and his colleagues found that the better the vaccine strain matched the circulating viruses, the better the vaccine was at protecting elderly nursing home residents. They argue that this indicates that the vaccine protects people living in nursing homes from serious outcomes associated with influenza infection.

This isn’t an approach we can take with other types of vaccines. It’s only possible because the flu vaccine changes from year to year. “What we’ve used is the randomness of the match,” Mor said in a statement. “Ours is the first study to, we think, come up with an unbiased approach.”

Though this study probably won’t settle the controversy about how well the vaccine works in older people, it does offer a different way to look at the question. A variety of other novel approaches are probably what it will take to get a handle on this hard-to-understand aspect of influenza.

Previously: Science Friday-style podcast explains work toward a universal flu vaccine, Study: Pregnancy causes surprising changes in how the immune system responds to the flu and Gut bacteria may influence effectiveness of flu vaccine
Photo by Cynthia Goldsmith

Infectious Disease, Public Health, Research, Stanford News

Hikers beware: New tick-borne disease discovered in Northern California parks

Hikers beware: New tick-borne disease discovered in Northern California parks

dan with wood rat 3Meet Dan Salkeld, PhD, a disease ecologist and friend, shown here looking for ticks on a wood rat from the San Francisco Bay Area. According to Popular Science, he has one of the worst jobs in science: tick collecting.

But thanks to the nitpicky diligence of Salkeld and co-author Eric Lambin, PhD, a senior fellow at the Stanford Woods Institute for the Environment, Bay Area residents now know that getting sick from a tick bite is a real and present danger — in a recent study published in PLoS One, the researchers found that 10.6 percent of young nymph ticks and 8.1 percent of adult ticks harbored the disease-causing bacteria Borrelia miyamotoi and/or Borrelia burgdorferi, the causative agent of Lyme disease. (See map below for tick collection areas.)

“We continue to be surprised by the number of ticks carrying Borrelia burgdorferi and Borrelia miyamotoi throughout the Bay Area, and we believe more research into the connections between human disease and strains and species of bacteria is critical,” said Salkeld. “It was astonishing that we could see such variety in tick ecology, ranging from low tick infection risk on one trail to high tick infection risk on another trail in the same park.”

First discovered in the United States in 2013, the most extensive analysis of Borrelia miyamotoi infections in U.S. residents was published in the July issue of Annals of Internal Medicine. In this study, 51 patients from the Northeast were found to be “frequently very ill” with fever, headache (often severe), muscle pain, fatigue and joint pain. Almost one quarter of the patients required hospitalization. The researchers also found that the miyamotoi infections were not reliably detected by the standard two-tiered Lyme blood test and these patients didn’t develop the hallmark sign of Lyme disease, the bullseye rash.

“This research offers some insights into the complexity of diagnosing patients with tick-borne diseases, and the need for medical professionals to be alert to the different symptoms of this newly discovered infection,” said Linda Giampa, executive director, of the Bay Area Lyme Foundation, which funded this study.

The Bay Area Lyme Foundation also funds a number of projects at Stanford’s Lyme Disease Working Group, which is exploring ways to improve diagnostic tests, evaluate the effectiveness of innovative therapies, expand clinical services and build greater public awareness of tick-borne diseases.


Previously: Stanford study finds Lyme disease among ticks in California parksAdd a tick check to your vacation checklistPiecing together the clues: Diagnosing and treating autonomic disorders
Photo courtesy of Bay Area Lyme Foundation; map from PLoS One

Behavioral Science, In the News, Infectious Disease, Research, Stanford News

Irrational fear of contagion fuels xenophobia, Stanford study shows

Irrational fear of contagion fuels xenophobia, Stanford study shows

face-mask-98640_1280I have a very distinct memory of my grandfather dying from leukemia in an Iowa hospital. I peered in through a glass window, too scared to don the white mask and gown to visit him myself, even though the protections were for him, not me. Granted, I was eight. But fear of disease, and fear of those who have disease, makes perfect sense to me, even now.

But, that realization is tempered by knowledge of the harmful effects of irrational fear, the topic of a recent study by a team of Stanford researchers. As described in a recent Graduate School of Business story:

Throughout history, minority or “out” groups have been blamed for the spread of infectious disease. In medieval Europe, for instance, Jews and gypsies were among those accused of spreading the deadly bubonic plague. In 1793, during the yellow fever epidemic in Philadelphia, local officials singled out actors, vaudevillians, and artists for transmitting the disease. But what is it about the fear of contagion that makes otherwise rational people buy into rumors about those they consider to be outsiders?

Organizational behavior researchers Hayagreeva Rao, PhD, and recent graduate Sunasir Dutta, PhD, developed an online pilot study where one group was told a new strain of flu had emerged, then asked about their views on immigration. The control group was simply asked about immigration.

Not surprisingly, the group told about the flu was less likely to support immigrant legalization. Dutta said he is convinced the results would be even more striking in the real world:

Practically speaking, the implications are clear: “Don’t do immigration reform during flu season,” says Rao.

The study also demonstrates the power of rumors to spur fear, even ethnic violence, Dutta said. And it illustrates the need for proactive, responsive communications, particularly in the beginning stage of epidemics when irrational fears can germinate.

Previously: Fear factor: Using virtual reality to overcome phobias, Fear of recurrence an issue for some cancer survivors and Looks of fear and disgust help us to see threats, study shows
Image by Openicons

Infectious Disease, Medical Education, Public Health, Research, Stanford News

A how-to guide on “galvanizing medical students” to administer flu vaccines

A how-to guide on "galvanizing medical students" to administer flu vaccines

image001Stanford’s Flu Crew, an initiative that gets medical students out into the campus and greater community administering flu vaccines, recently published a paper validating the importance of such initiatives for medical education and public health, and enumerating its best practices so other programs can follow in its footsteps.

Rachel Rizal and Rishi Mediratta were Flu Crew’s co-directors when we first wrote about their work in 2012. Rizal is now a fifth-year student and Mediratta a pediatrics resident at Stanford. They are lead authors on the article, “Galvanizing medical students in the administration of influenza vaccines: the Stanford Flu Crew,” which appears in the journal Advances in Medical Education and Practice.

I learned a lot about Flu Crew in an email exchange with Rizal, Mediratta, and a host of people they said were instrumental in this accomplishment. Catherine Zaw, a Stanford undergraduate who is a co-author on the recent paper, told me,”The Flu Crew concept has already spread to a couple of schools around the Bay Area, including UCSF, and I hope that with the publication of the paper, more medical schools will consider adopting it.”

The article is essentially a blueprint for replicating Flu Crew in other institutions. It describes Flu Crew’s innovative online-based curriculum, created by former Stanford medical student Kelsey Hills-Evans, MD (which she discussed in a post earlier this week). It lays out the planning needed to coordinate vaccination events, which in their case involves the medical school, undergraduate volunteers, the Vaden Student Health Center, Stanford’s Occupational Health Clinic, and community institutions like churches, libraries, and homeless shelters. And finally, it explains the impact on medical students’ attitudes to population health, as one of its main goals as a service-learning program is to provide students with experience in public health and patient interactions early on in their career.

Imee DuBose, MPH, who worked as operations manager at Occupational Health and was inspired by the “impressive professionalism” of Flu Crew’s student leadership to shift her career to student advising, told me: “As a public health professional, I see Flu Crew promoting community health through collaboration, and as a student affairs professional, I see student development and growth – this project combines the best of both worlds.”

Rizal and Mediratta’s successors for the two-year director position, Lauren Pischel and Michael Zhang, were also co-authors. Pischel explained that she thinks public health and preventative medicine are incredibly important in medical education.

“Campaigns like this link the individual you see sitting before you in clinic with the health of the population at large,” she said “I would like to see this paper be used to talk about how we can effectively integrate public health teaching and experience into medical school. There is quite a bit of room to grow in this direction.”

Previously: Stanford Medicine grads urged to break out of comfort zoneAn ounce of action is worth a ton of theory: Med student encourages community engagementFrenemies: Chronic cytomegalovirus infection boosts flu vaccination efficacyFlu Near You campaign aims to improve monitoring of flu outbreaks, vaccinations and Student “Flu Crew” brings no-cost flu vaccinations to the community
Related: The Flu Crew: Med students provide vaccinations to the community
Photo, of medical student Lichy Han administering a flu vaccine to Dean Lloyd Minor, MD, in 2012, courtesy of Imee Diego DuBose

Infectious Disease, Medical Education, Medicine and Society, Public Health, Stanford News, Videos

Online curriculum helps students and public learn about influenza

Online curriculum helps students and public learn about influenza

Stanford’s Flu Crew, which administers flu vaccines in and around the Stanford community, has had many successes over the last few years, which we’ll highlight in a post later this week. One achievement I thought deserved special attention is an innovative curriculum on influenza created by former medical student Kelsey Hills-Evans, MD, now an internal medicine resident at Harvard. Her online videos, such as the one above (which is the first in the series), are accessible not only to Flu Crew’s student participants but the public at large.

The videos were produced via a partnership with Khan Academy and built on the flipped classroom model championed by Charles Prober, MD, senior associate dean of medical education. They also received the Shenson Bedside Innovation Award in 2013. Rishi Desai, MD, a Stanford pediatric infectious disease physician and medical fellow at Khan Academy, supervised Hills-Evans’ efforts and told me in an email that Hills-Evans and the Flu Crew “put together some really amazing videos explaining everything from the basics of influenza to common misconceptions and fears that people have about the flu vaccine. They deserve all of the credit for the idea and execution of the project.”

Hills-Evans tried to keep each video under five minutes: “I wanted it to be a quick, high-yield snapshot of information that people could watch in one sitting and not easily forget.” She shared more details with me over email:

What did you aim to convey in these training videos? How did you imagine your audience? 

I wanted our student volunteers to come away from the training with enough general knowledge about influenza to answer nearly any question that patients might have. We equipped them with knowledge about its history, how it genetically changes over time, the clinical symptoms, the vaccine’s risks and benefits, specific patient populations, and even a section on flu shot myths. Our last video was meant for students to become public-health advocates equipped with facts and counter-arguments to some of the most common excuses people have for not protecting themselves with the flu vaccine.

For these general info videos, I was really aiming to be accessible to the general public. The topics are all applicable to the lay person, so I tried my best to stay away from clinical jargon. I wanted people to come away from the training with a better understanding of how dangerous influenza can be – many people shrug at the flu as a bit worse than a winter cold, but it kills tens of thousands of people every year. In addition, there are so many myths generated by popular media and the public about the illness itself (i.e., “I got a stomach flu” which is never actually an influenza virus) and especially about vaccines. It was important to me that we make these videos public so more individuals could be informed.

For the sections meant only for clinical personnel, our priority was to train the members of the Stanford Flu Crew, but I also wanted this component to be exportable to other medical programs. It was meant to teach students to deliver the best intramuscular (IM) injections possible. We’ve been told countless times that our method for IM injections yields extremely high patient satisfaction and nearly pain-free injections (some say “the best flu shot they’ve received”).

Continue Reading »

Infectious Disease, Media, Public Health, Stanford News

Stanford doctor-author brings historic figure Jonas Salk to life

Stanford doctor-author brings historic figure Jonas Salk to life

JacobsStanford professor emerita Charlotte Jacobs, MD, spent the past decade with the ghost of polio vaccine creator Jonas Salk, MD, the subject of her second biography, Jonas Salk: A Life. She dug through archives, conducted over a hundred interviews and read countless first-hand accounts and period news.

But she still had a difficult time choosing the opening scene for her book, the first written biography of the man hailed as an international hero for his role in ending the polio epidemics that ravaged the world during the first half of the 20th century.

Should she start with start with Salk’s humble beginnings as a child born to poor Jewish immigrants in New York City, dive into the life-saving research that propelled him to fame and antagonized his scientific peers, or begin at the end of his life, when he was striving to regain his prestige by seeking an HIV vaccine?

The choice for Jacobs became clear when, during a dinner at a writers’ residency, she described her book and its subject to her fellow participants. As the mostly younger writers quietly nodded, Jacobs realized they not only didn’t know who Salk was, they had no idea of the scope or severity of the polio epidemics. Jacobs, a child during the 1950’s, has chilling memories of this time.

Salk book cover“It was a fear that hovered over us every summer,” Jacobs recalled, “no matter what you did — eat your vegetables go to church, mind your mother — you could be the crippler’s next victim. And it was mostly children who caught the disease.”

Jacobs begins her book, excerpted in the new issue of Stanford Medicine, with a vivid account of the New York City 1916 outbreak. That year, in New York state alone, 8,900 people were infected, 2,400 died and many of the survivors were paralyzed or crippled.

The book has received numerous positive reviews. While Jacobs is happy with the attention, she is most excited for her audience to learn about the remarkable work that Salk and his team did in developing the vaccine and how the American public, through the March of Dimes, funded and carried out the first vaccine trials.

“This trial was run by volunteers; housewives collected the data,” she said. “Never before, and never again, has the public itself conducted a trial of this magnitude.”

Having read the excerpt in Stanford Medicine, I’m eager to read more.

Kim Smuga-Otto is a student in UC Santa Cruz’s science communication program and a writing intern in the medical school’s Office of Communication and Public Affairs.

Previously: This summer’s Stanford Medicine magazine shows some skinHenry Kaplan’s crusade against Hodgkin’s disease, TED Talk discusses the movement to eradicate polio, and Researchers tackle unusual challenge in polio eradication
Photo by Max Aguilera-Hellweg

Stanford Medicine Resources: